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COUNTY Dutchess
CITYfTOWN WappinQer
~~~~~c~ 1368
~~~I~~~R 28
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Kenneth Timoth~ Martin
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Denise Ann D' Apice
MIDDLE CURRENT 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 Martin
(OPTIONAL. SEE REVERSE) 071 62-9655
D. SOCIAL SECURITY NUMBER -
12. RESIDENCE A, NY 8 Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinqer
D. STREET ADDRESS 87 Kent Road
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER 061-62-2925
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY otJ TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D. STREET ADDRESS 87 Kent Road ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES '6 NO
07 / 07 / 1970
MONTH DAY YEAR
ZIP 12590
OYES~NO
/1'977
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE'
13. A. AGE 31 38. DATE OF BIRTH 03 /21
MONTH DAY
3. A. AGE ::\7
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Paramedic
B. TYPE OF INDUSTRY OR BUSINESS EMS
5. PLACE OF BIRTH Rhinebeck. New York
(CITY, STATE I COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Business Consultant
B. TYPE OF INDUSTRY OR BUSINESS Finance
15. PLACE OF BIRTH Yonkers, New York
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
16. FATHER
A. NAME K~nn~th Wright Martin Jr
B. COUNTRY OF BIRTH U S A
7. MOTHER
A. MAIDEN NAME Pamela Turner Savage
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
A. NAME Anthony Patsy D'Apice
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Laura Ann Fatiuk
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 2
DEATH
o
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) r1 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 04 / 30 / 2007
MONTH DAY" YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~YES 0 NO
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) I!l'DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGEENDED? 12/ 21 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED. PROVIDE THE FOLLOWING INFORMATION 20.
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY. YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
12/21/2007 Poughkeepsie, New York 0 ~ 1ST
o 0 2ND
o 0 3RD
o 0 4TH
my knowledge and belief that the information I provided is tru
DEATH
o
(2) 0 DEATH
2007
YEAR
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and sa
as to my right to enter into the
21. SIGNATURE OF GROOM ~
~
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
04/30/2007 Poughkeepsie. New York
r:f
o
o
o
o
22. SIGNATURE OF BRIDE~
exists
w
en
z
w
o
::i
23. SUBSCRIBED AND SWORN O/AFFIRMED BE
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 ~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
{ } NAME (PRINT) ~ ~~
SEAL SIGNATURE ~ " C. ~ DATE 04/110008
MAILING ADDRESS .
'-v-I 20 MiddleblJsh Rd, Wapoinaers Falls, NY 12590
STREET ClTYii'6'WN STATE ZIP
~~~R~~~Ri:~~ lo~O~~~N~Zi~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 ~CIVIL
DATE AND AT THE TIME AND AM
PLACE INDICATED. ~ ~ ?o PM
06
10 2008
DATE
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
DAY
YEAR
YEAR
TIME
MONTH
AM
02:27PM
04
12
2008
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNTY~
29. OFFICIANT
NAME (PRINT)
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF '$ VILLAGE OF