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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Greaorv William Bridle
FIRST M1DDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
DISTRICT 1368
NUMBER
~5~::~R 50
1. A. FULL NAME
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 1 00-58-7307
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r! TOWN 0 VILLAGE
~~~CIFY pouQhkeeesie
D. STREET ADDRESS 9 Mc afferty Place, Apt. #~P 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? dYES 0 NO
3. A. AGE 37 3B. DATE OF BiRTH 06 / 23 / 196
MONTH DAY YEAR
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4. EMPLOYMENT
A. USUAL OCCUPATION Carpenter
B, TYPE OF INDUSTRY OR BUSINESS Construction
5. PLACE OF BIRTH Town Of Cortlandt, New York
(CITY, STATE I COUNTRY IF NOT USA)
S. FATHER
A. NAME Charles Norman Bridle
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Anna A. Schlichting
B. COUNTRY OF BIRTH USA
1
8. NUMBER OF THIS MARF,lIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PElEViOUS .MARRIAGES.WHiCH.ENDED BY
D1VO~CE CIVIL ANN~LMENT
DEAlf
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY
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. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
YEAR
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Jennifer Susan Conley
MIDDLE CURRENT SURNAME
.J
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Brid Ie
(OPTIONAL - SEE REVERSE) 521-29-6631
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE)..J (COUNTY)
C. CHECK ONE 0 CITY LJ TOWN 0 VILLAGE
~~CIFY Poughkeep_sie
D. STREET ADDRESS 9 Mc Cafferty Place, Apt. #\IP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
10 /02 /1973
DAY YEAR
13. A. AGE 33
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Homemaker
B. TYPE OF INDUS~RY OfUll,JSINESS
15. PLACE OF BIRTH ",an ulego, California
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Harrest Leon Conley
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Margaret Louise Wittner
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV8RCE CIVIL AN~LMENT
DE'1f
(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. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 0 1~ 0 0
o 0 ~D 0 0
o 0 3RD 0 0
o 0 4TH 0 0
nowledge and belief that the information I provided is true and that I declare that no legal impediment exists
22. SIGNATURE OF BRIDE ~ C\.. /'VVV\ ~ (l <,>1 C ~. ~^"ili -<.1,"--
· i:3" ~RRENTNAME 06/15/207
DATE
Q
Z
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NAME (PRINT)
DATE
1ST
2ND
3RD
4TH
I dul swear/affirm, deP.Ose and sey, that to the
as to my right to enter into the mamage state.
21. SIGNATURE OF GROOM~
23. SUBSCRIBED AND SWORN TOIAF MED BEFORE E
SIGNATURE OF TOWN OR CITY ERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
W Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
UJ 0 If checked, this license is to be used only for the urpose of a second or subsequent ceremony.
Z ~ 24. TOWN OR CITY f6 R~ C. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
W { } NAME (PRINT)
~ SEAL SIGNATURE ~. DATE 06/15/200 YEAR MONTH
MAIL2e~e appinger Falls, NY 12590 2007 08 14 2007
'-.,-I
YEAR
ZIP
STREET
f CERTlFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
STATE
27. TYPE OF CEREMONY
o-i!-RELIGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY k.-rlcitec.S
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF B'VILLAGE OF
SPECIFY tJt%-ffINr~ {'ctl/s
TITLE If 19c1-o/"
7}~ Ip "}
Jt? tJ't-t f Ivt.eM~ , JVL--j I z...(p eJ /
. r STATE I ZIP
31. WITNESS T EREMONY
. .(1'
NAME (PRINT)
Zo07
"'S:r.
w
!;;c 29. OFFICIANT
(.) NAME (PRINT)
!:!: SIGNATURE ~ W U
... MAILING ADDRESS
ffi ..2~~~ & ,~dk ,eel I ~""';O~; "
(.) 30, WITNESS TO CEREMO
It
~L
SIGNATURE~
DOH-98 (0312006)
SIGNATURE~