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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
nAnnis Mich~AI McM~hon, II
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN WappinQer
1368 '
16
DISTRICT
NUMBER
REGISTER
NUMBER
1, A, FULL NAME
FIRST
"-
N
B, BIRTH NAME, IF DIFFERENT
C, SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 077-68-3054
D, SOCIAL SECURIiY NUMBER ___ __ ___
2, RESIDENCE A NAw York B, nlltchASS
(STATE) (COUNTY)
C, CHECK ONE 0 CITY CY'TOWN 0 VILLAGE
~~~CIFY East Fishkill
D, STREET ADDRESS 35 Brandv Lane ZIP 12590
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES D""'NO
3, A, AGE ?~ 3B, DATE OF BIRTH 11 / ?9 / 19A
MONTH DAY YEAR
4, EMPLOYMENT
t-
oo
A, USUAL OCCUPATION Correction Officer
B, TYPE OF INDUSTRY OR BUSINESS New York State
5, PLACE OF BIRTH Manhattan. New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
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c:(
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A, NAME nAnnis Mich~AI McM~hon
B. COUNTRY OF BIRTH USA
7. MOTHER
A, MAIDEN NAME Linda Marie Mahoney
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARF,lIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
(2) 0 DEAJH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
I
STATE FILE NUMBER
(TH/S SPACE FOR STATE USE ONL Y)
I
N(}t U~tD
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Stace~ Leigh O'Dell
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE McMahon
(OPTIONAL - SEE REVERSE) 070 68 5283
D. SOCIAL SECURIiY NUMBER --
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 "",,"OWN 0 VILLAGE
~~~CIFY East Fishkill
D. STREET ADDRESS 35 Brandy Lane
12590
ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES D....NO
08 / 25 /1983
MONTH DAY YEAR
13. A. AGE
23
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Legal Assistant
B. TYPE OF INDUSTRY OR BUSINESS Warren Wynshaw P C
15. PLACE OF BIRTH Poughkeeosie. New York
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Earl James 0' Dell
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Patricia E. Lyons
B. COUNTRY OF BIRTH USA
1
1 B. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH OAY
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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
,',- YEAR
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I duly swe!lr/affirm, dep.ose and say, that to the best of my knowledge and belief that the information I provided is true an
as to my nght to enter Into the mamage state.
21. SIGNATURE OF GROOM. 22. SIG TURE OF BRIDE.
w
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W
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USE CU RE
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of
Relations Law ~11 to perform marriage ceremonies within New York
o If checked, this license is to be use
24. TOWN OR CITY CLERK
NAME (PRINT) 0
e bride and groom named above by any person authorized
tate. THIS LICENSE VALID IN NEW YORK STATE ONLY.
only for the purpose of a second or subse uent ceremony.
25. A. SOLEMNIZATION PERIOD BEGINS
~
{ SEAL }
'-v-I
o 0
o 0
o 0
o 0
no egal impediment exists
03/08/2007
DATE
by New York Domestic
TIME
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
YEAR
MONTH
DAY
YEAR
in
frO
26. SOLEMNIZATION OCCURRED
TIME M. DAY YEAR
DATE 03/08/20
er Falls NY 12590
STATE ZIP
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
AM
PM
29. OFFICIANT
NAME (PRINT)
TITLE
SIGNATURE ~
MAILING ADDRESS
DATE
STREET
30. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~
OOH-98 (D3I2006)
CITYfTOWN
STATE
AM
02:1 fM
03
09
200
05
07 2007
2B. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~