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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Bryal"1~!1drE'\AI SW~gl~~RNAME
COUNTY nl ltchp.ss
CITYfTOWN Wappinger
~~~:~c; 136R
~~~I:~~R 14
1 . A. FUU NAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 113-6?-6606
2. RESIDENCE A. NYsTATE) B. qc'd6~E'SS
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND \^' .
SPECIFY appm!)E'r
D. STREET ADDRESS 7 A r.::Jrn::Jhy Strp.p.t ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES otJ NO
MO~ / ~~ / y1ifl9
3. A AGE 28
4. EMPLOYMENT
A. USUAL OCCUPATION Fimmcial Analyst
B. TYPE OF INDUSTRY OR BUSINESS IBM
5. PLACE OF BIRTH C~ Of Elmira NE'w York
(CI ,STATE / COUNTRY IF NOT USA)
6. FATHER
3B. DATE OF BIRTH
l-
S;
c:(
C
u:
u..
c:(
A NAME James Alan Swarthout
B. COUNTRY OF BIRTH I I S A
7. MOTHER
A. MAIDEN NAME Rose Anne Cicconi
B. COUNTRY OF BIRTH I I S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
OEATH
o
(2) 0 DEATH
o
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
C. DATE LAST MARRIAGE ENDED?
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
I ::Jllrp.n Kristinp. UraLJhart
MIDDLE CURRENT SURNAME
-.J
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE S \AI::! rt h n lit
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 063-72-2492
12. RESIDENCE A. NY B nlltr.hp.ss
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN it'! VILLAGE
~~~CIFY Village Of Fishkill
o STREET ADDRESS 1 04 Village Common ZIP 12524
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
Alq /'f q77
DAY YEAR
13 A AGE 30
11
MONTH
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION HI Im::Jn Rp.snllrr.p.s
B. TYPE OF INDUSTRY OR BUSINESS IBM
15 PLACE OF BIRTH r.itv Of Pouahkeeosie, New York
(CITY:STATE / COUNTIlY IF NOT USA)
16. FATHER
A. NAME lamE'S Robert I Jrrl' Ih::!rt
'B. COUNTRY OF BIRTH I J S A
17. MOTHER
A MAIDEN NAME Sh::Jrnn I P.P. Morris
B. COUNTRY OF BIRTH I J S A
18. 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 (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
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 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 that I declare that no legal impediment exists
as to my right to enter into the m rnage state.
21.SIGNATUREOFGROOM~ -4 .J22.SIGNATUREOFBRIDE~~ k-tl/n.A~ ~
USE CURRENT NA~
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFO 03/n7/?oon
SIGNATURE OF TOWN OR CITY CLERK ~ DATE _________0
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to pertorm marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o " 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) JOhnYi' ~~~~
{SEAL SIGNATURE ~ <...... CJ.I! ~lk:) DATE 03/07.'''00,
MAILING ADDRESS -,' .
"-v-I STR~ Middlebush Rd, Wap~rs Fiillls15T~;r' 1259gp
~~~R~~Ri~~~ IO~O~~~N~ZE~ 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 B-1fELIGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
29. OFFICIANT
NAME (PRINT)
TITLE
NAME (PRINT)
SIGNATURE~
DOH-98 (03/2006)
TIME
MONTH
MONTH
YEAR
YEAR
AM
03: 11PM
03
06 2008
08
2008
05
Art~
'O~ ;j .'
s::
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ?>afck
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY ~F P TOW"lOF B""ViLLAGE OF
SPECIFY + M h JuJl7 fJj
31.
NAME (PRINT)
SIGNATURE~