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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Miir~~dr&w H~ii'iMfsURNAME
COUNTY DlltchF>SS
CITYfTOWN W<3rringF>r
~~~:~c; 1368
~E~I~;~R R R
1. A. FULL NAME
FIRST
ll.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 087 -68-8939
2 RESIDENCE A. NV B. nl,t,..hilSS
[STATE) "i""c'Elrn:l'f'(J
C. CHECK ONE 0 CITY.j2J TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS qn ~r.::Irhnrnlloh I n ZIP 1 ?fiqO
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
MO~ / m:> / y1j81
3. A AGE 27
4. EMPLOYMENT
3B. DATE OF BIRTH
A USUAL OCCUPATION Portfolio Assistant
B. TYPE OF INDUSTRY OR BUSINESS Finallce
5. PLACE OF BIRTH ~1~,Fl\~9~t~ur;JtR!'P;;0T USA)
6. FATHER
A. NAME Roniild '.^/illiam Hudson
B. COUNTRY OF BIRTH I I S A
7. MOTHER
A. MAIDEN NAME Margaret Lind(3 Gllndersel1
B, COUNTRY OF BIRTH I I S A
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
(2) 0 DEATH
o
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
13) 0 ANNULMENT
/ /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kristif;JlI[~iijzabeth ~l(~~~SURNAME
-.J
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C sY~~~:~M~~~re^~~~~~st'udson
0, SOCIAL SECURITY NUMBER 1 OR-74-fi7QO
12, RESIDENCE A. NY 8. D'lt,...!',IOlSS
(STATE) (t:151l11i'1'!'
C CHECK ONE 0 CITY ijl TOWN 0 VILLAGE
AND '^' '
SPECIFY \ apr1noF>r
D. STREET ADDREss9D ~r.;:)rboroIJgh I n ZIP 1 ?590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
Q~TH /()~AY /'j' ~p
13. A, AGE 27
14. EMPLOYMENT
A, USUAL OCCUPATION Microbiologist
B. TYPE OF INDUSTRY OR BUSINESS RF>~F>::Irr.h
15. PLACE OF BIRTH NF>W Rnr.hF>lIF> NY
(CITY, STATE / COUNTRY IF NOT USA)
3B. DATE OF BIRTH
16, FATHER
A, NAME Richard Allan Da"ies
B. COUNTRY OF BIRTH I J ~ A
17. MOTHER
A. MAIDEN NAME .1F>::mnF> Ann Mr. KF>nn::l
B. COUNTRY OF BIRTH I J ~ A
1B. NUMBER OF THIS MARRIAGE 1
19, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
o
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT 12) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / (.
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I duly swear/affirm, depose and say, that to the best of my knowledge and belief that the information I provided is true and
as to my right to enter into the ,l~f~ge ~e,
21. SIGNATURE OF GROOM ~ . 7~ ~ 22. SIGNATURE OF BRIDE ~
o 0
o 0
o 0
o 0
al impepiment exists
USE
23, SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New ork State of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY,
o If checked. this license is to be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
~
{ SEAL }
'-..t-'
DATE
OR/11/?OOR
by New York Domestic
TIME
MONTH
STREET ITY STATE
~~~R~~~RT~~~ IO~O~~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 l8 RELIGIOUS
DATE AND AT THE TIME AND AM
PLACE INDICATED. -<I ;OlCJPM (7 ~ iVo.:J..L7l' f? 9 0 OTHER, SPECIFY
29 OFFICIANT :I;> / 1-" Cnrot."'11 I A '7:;r . /, .
NAME (PRINT) f J <::d:J e r: r.:/ /;,/0 ..J' TITLE V I Cc. r
SIGNATURE~~~.LV Q DATE..::r~ 2A:lJ ~:?'
MAILING ADD S ' t. 1/. r
((f)~ '€Ar'lo--ok fCcf c,~ (,...~ 5/~ /JY '260.2>
STREET CITYfTOWN
30. WITNESS TO CEREMONY
NAME (PRINT) \ V,'" A I
NAME (PRINT)
SIGNATURE~
DOH-98 10312006\
MONTH
YEAR
YEAR
AM
06:46PM
06
12
2008
08
1 0 2008
10 CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNTYlu fCWe.S5
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF Qg VILLAGE OF
SPECIFY f/J.'1 f //1 J (.,.... r;... II:;.
STATE
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) 1'1.,. 4--1 J,., (' lA ;1 { J<,c';~
.-~ .:;7
...--">~~ ~.
SIGNATURE~