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DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Keith Alvin Abrams
MIDDLE CURRENT SURNAME
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
? 0
B. HOW DID LAST MARRIAGE END? (3) !!'l DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 09 / 06 / 1996
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? i'!r'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
09/06/1996 Goshen. NY 0 r!'5 1ST
o 0 2ND
o 0 3RD
o 0 4TH
owledge and belief that the information I provid
23. SUBSCRIBED AND SWORN O/AFFIRMED BEFOR
SIGNATURE OF TOWN OR CITY CLERK.
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11to 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
NAME (PRINT)
COUNTY Dutchess
CITYITOWN WappinQer
~~~:~c; 1368
~G~'~:~R 44
1. A FULL NAME
FIRST
ll.
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 86
D SOCIAL SECURITY NUMBER 097 -40-62
2 RESIDENCE A. NY B Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY..o TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D. STREET ADDRESS 10 Alpine Drive; Apt E ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES"6 NO
12 /24 /1953
MONTH DAY YEAR
3. A. AGE 54
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Burner Technician
B. TYPE OF INDUSTRY OR BUSINESS Oil Heat
5. PLACE OF BIRTH Cornwall. NY
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Elmer Alvin Abrams, Jr
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Catherine Triggiani
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 3
DEATH
o
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and sa
as to my right to enter into the ma
W
en
z
W
o
::i
~
{ SEAL }
'-v-'
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Linda Frances Schendel
MIDDLE CURRENT SURNAME
~
11. A FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)131_46_4 754
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANY BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY WappinQer
D. STREET ADDRESS 10 Alpine Drive; Apt E
ZIP 12590
DYES '6 NO
;(959
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 49 3B. DATE OF BIRTH 01 /f 0
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Nurse
B. TYPE OF INDUSTRY OR BUSINESS Healthcare
15. PLACE OF BIRTH Buffalo , New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Robert Schendel
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Gertrude Staley
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
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
DATE 05/05/2008
by New York Domestic
TIME
YEAR
MONTH
YEAR
MONTH
DATE 05/05/2008
ers Falls NY 12590
WN STATE ZIP
27. TYPE OF CEREMONY
05
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
, E. TITLE _Vi U (}Crt. ~ r", (:.6
DATE JlJtHl J~ ~ ~
Aff';f\R~~~ f41' '~9d
STATE ZIP
MONY
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29. OFFICIANT .)
NAME (PRINT) V!
AM
02:01 PM
07
04 2008
06
2008
l~CIVIL
28. PLACE WHERE MARRIAGE OCCURRgD
A. STATE NEW YORK B. COUNrvlJ-J 1'CJI,k.-5:S
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY L)J if ~ )I,{ ()-E. 0:1
NAME (PRINT)
SIGNATURE.