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COUNTY Dutchess
CITYITOWN Wappinger
~~~:~CRT 1368
~~~I~~~R 31
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
IAffrAV M FAinman
. MIDDLi CURRENT SURNAME
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
We~lg~E Ellen Saf[~~NT SURNAME
~
1. A. FULL NAME
11. A FULL NAME
FIRST
FIRST
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Safran
(OPTIONAL - SEE REVERSE) 1 5
D. SOCIAL SECURITY NUMBER 058-40-79
12 RESIDENCE A. NY B Dutchess
(STATE) (COUNTY)
C. CHECK ONE D CITY ~ TOWN D VILLAGE
AND W .
SPECIFY apOlnqer
D. STREET ADDRESS 10 Ada Dr.
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 093-38-0634
2 RESIDENCE A. NY B. nlltr.hA~~
(STATE) (COUNTY)
C CHECK ONE D CITY ~ TOWN D VILLAGE
AND W .
SPECIFY apprngAr
D STREET ADDRESS 10 Ada Dr.
ZIP 12590
DYES '6 NO
/1'955
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
01 /
MONTH
ZIP 12590
DYES oC NO
14 /1q47
DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 53 38. DATE OF BIRTH 03 /1 0
MONTH DAY
3 A. AGE 61
3B. DATE OF BIRTH
....
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4. EMPLOYMENT
A. USUAL OCCUPATION Psych()lnoi~t
B. TYPE OF INDUSTRY OR BUSINESS HAalth Care
5. PLACE OF BIRTH NAW Y nrk NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Leonard David Feinm::ln
B. COUNTRY OF BIRTH I ) S A
7. MOTHER
A. MAIDEN NAME I\II::1rr.i::l ~Iir.k
B. COUNTRY OF BIRTH I J S A
8. NUMBER OF THIS MARRIAGE 3
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
14. EMPLOYMENT
A. USUAL OCCUPATION ParaleQal
8. TYPE OF INDUSTRY OR BUSINESS Leaal
15. PLACE OF BIRTH Queens, NY
(CITY, STATE / COUNTRY IF NOT USA)
2
DEATH
n
16. FATHER
A. NAME Stanley Safran
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Helene Claire Lamb
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH
1 0 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) D ANNULMENT (2) D DEATH
C. DATE LAST MARRIAGE ENDED? 10 / 27 / 1995
MONTH DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ['(YES D 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 1007/1995 White Plains, NY [!" D
2ND D D
3RD D D
D D
pediment exists
o
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) D ANNULMENT
C. DATE LAST MARRIAGE ENDED? 12/ 23 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? IYYES 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
1ST 12/23/1993 POlIghkeepSiE>, Ny D
2ND D
3RD D
4TH
(2) D DEATH
1qq~
YEAR
22. SIGNATURE OF BRIDE
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USE R
23. SUBSCRIBED AND SWORN T I IRM BEFORE ME
SIGNATURE OF TOWN OR CITY CLER ~
This license authorizes the marriage in New k 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,
D ff-roecked;1his-ticense-is-to-be-used only1or~ose -ofll-second -or-subsequent--cerenlO"y,
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
by New York Domestic
~
{ SEAL }
'-v-I
NAME (PRINT)
MONTH
YEAR
YEAR
TIME
MONTH
AM
05:35PM
04
17
2008
06
15 2008
N
TATE
27. TYPE OF CEREMONY
o ~ RELIGIOUS
9 D OTHER, SPECIFY
1 D CIVIL
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~(AP.rhr
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF D TOWN OF ~LAGE OF
SPECIFY 1li Y'V''t ..]0 bJ n
mftV
/