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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
WA~~~t~ .lnn;:!th;:!~URM~~tRNAME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEF
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State of authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New Yo tate. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used onl urpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY pL RK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRIN1) JO C. Masterson
{TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ .
MAIL~O~ffieb j.M 09 11 2007 11 09 2007
'-v-I 12:2-t>M
COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~ 1368 .
~~~:~~R 114
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 047-82-5961
D. SOCIAL SECURITY NUMBER --- -- ----
2. RESIDENCE A. NY B. nlltchA!,;!,;
(STATE) (couNTY)
C. CHECK ONE 0 CITY [jI' TOWN 0 VILLAGE
AND W .
SPECIFY appmger
D. STREET ADDRESS Carnaby Street. ADt. 2 D ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES rY NO
3. A. AGE ~? 3B. DATE OF BiRTH O~ / ?7 / 1975
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Systems Engineer
B. TYPE OF INDUSTRY OR BUSINESS I. B. M.
5. PLACE OF BIRTH Bridaeport. Connecticut
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Charles Most
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Carol Sedlak
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE'--- ---- -- ----CIVIL-ANNUtME~-
o 0
---DE'ATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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) (CITYICOUNTY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
"I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
MeQrDan Ann Lapu~~~ SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 047 80 8056
D. SOCIAL SECURITY NUMBER --
12. RESIDENCEA. N Y B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY []I' TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS Carnabv Street, Apt. 2 D ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
05 /21 /1980
MONTH DAY YEAR
13. A. AGE ?7
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Student
B. TYPE OF INDUSTRY OR aUSINESS D. C. C.
15. PLACE OF BIRTH Hartford , Connecticut
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME William James Landon
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Kim Alison Bovard
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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.-- YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
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) (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
o
o
o
YEAR
CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEWYORK B.cou~lI~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF ~VILLAGE OFT: It
SPECIFY WIJtrfJP, 1\AS.;.n..S ~
29. OFFICIANT
NAME (PRIN1)
TITLE -::rvSTJ'-'ct.
DATE /ol.Jtj'241D7
STATE
ZIP
31. WITNESS TO CEREMONY
~ E"\ \ 'e...~ c...- w~.
,()J.~ . ~~
NAME (PRIN1)
SIGNATURE~