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COUNTY Dutchess
CITYffOWN Wappinger
~~~:~; 1 368
~~~I;~~R26
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
M::Irk .1::1\1 \Nnnrlw;:)rd
MIDDLE J CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
"I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Amanda Fallan Giddinas
MIDDLE CURREnT SURNAME
-.J
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 Woodward
(OPTIONAL' SEE REVERSE) 66 2565
D. SOCIAL SECURITY NUMBER 127- -
12 RESIDENCEA,NY 8. Clinton
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFY Keeseville. New York
D. STREET ADDRESS 16 Hill Street ZIP 12944
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? '6 YES 0 NO
/27 ,,1982
DAY YEAR
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 191-R4-9485
2. RESIDENCE A. NY 8. r.lintnn
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN~ VILLAGE
~~~CIFY Kee~eville New Yark
,
D STREET ADDRESS 16 Hill Street ZIP 12944
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
3 A. AGE 30 3B DATE OF BIRTH MoQl / 2.~ / .;1,~77
4. EMPLOYMENT
A. USUAL OCCUPATION ConSlllt::lnt
B. TYPE OF INDUSTRY OR BUSINESS Tr;:)n~rort;:)tion
5. PLACE OF BIRTH ne!:::jw::Ire PA
(CITY. STATE / COUNTRY IF NOT USA)
13. A. AGE ?fl
3B. DATE OF BIRTH
08
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Retail Manager
B. TYPE OF INDUSTRY OR BUSINESS Retail
15. PLACE OF BIRTH Plattsburgh. New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Willi;:)m George Giddings
. B. COUNTRY OF BIRTHU S A
17. MOTHER
A MAIDEN NAME Robin Darlene Carter
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
6. FATHER
A. NAME Robert L \^'oodward
B. COUNTRY OF BIRTH II S A
7. MOTHER
A. MAIDEN NAME Irenp Mnlnrlnwer.
B. COUNTRY OF BIRTH Germ::lny
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
n
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 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
o
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C, DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
YEAR
MONTH
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES
DAY
DNO
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
0 0 1ST 0 0
0 0 2ND 0 0
0 0 3RD 0 0
0 0
diment exists
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23. SUBSCRIBED AND SWORN TOI RMED BEFORE
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
by New York Domestic
~
{ SEAL }
'-v-I
NAME (PRINT)
YEAR
MONTH
YEAR
TIME
MONTH
AM
02:08PM
04
05
2008
06
03 2008
ZIP
TATE
27. TYPE OF CEREMONY
o ~GIOUS
9 0 OTHER, SPECIFY
10 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 el-l ;v'rei ;Y
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /'
o CITY ~FD OWN OF ~ILLAGE OF
. Ec'5 c. V/L-/ C
SPECIFY
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31.
NAME (PRINT)
SIGNATURE.