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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~~ 1368 .
~5~~;~R 12
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Jonathan Marlow Dunham
MIDDLE CURRENT SURNAME
FIRST
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Anne Marie Manoy
MIDDLE CURRENT SURNAME
-.J
1 . A. FULL NAME
11. A. FULL NAME
FIRST
0-
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 115 72 5516
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r!J' TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 18 Macfarlane Road ZIP 12590
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Dun h a m
(OPTIONAL. SEE REVERSE) 056-80-6711
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Oranae
(STATE) (COUNi"V)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Middletown
D. STREET ADDRESS 100 Straford Lane ZIP 10940
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES Ii NO
11 /23 /1984
MONTH DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES I!l' NO
12 / 28 / 1 981
MONTH DAY YEAR
3. A. AGE ?~
13. A. AGE 22
3B. DATE OF BIRTH
3B. DATE OF BIRTH
~
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4. IOMPLOYMENT
A. USUAL OCCUPATION Military
B. TYPE OF INDUSTRY OR BUSINIOSS Air Force
5. PLACE OF BIRTH Mount Kisco. New York
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Marlow Gene Dunham
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Tonya Zoann Deaton
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
14. EMPLOYMENT
A. USUAL OCCUPATION Military
B. TYPE OF INDUSTRY OR BUSINESS Air Force
15. PLACE OF BIRTH Middletown, New York
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Philip Joseph Manoy
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Eileen Theresa Brieger
B. COUNTRY OF BIRTH USA
1 B. NUMBER OF THIS MARRIAGE 1
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?
(3) 0 ANNULMENT
/ /
(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
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
w
en
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w
o
::::i
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say, that to the b
as to my right to enter into the marr est
21. SIGNATURE OF GROOM~
23. SUBSCRIBED AND SWORN IIFFIRMED BEFORE
SIGNATURE OF TOWN OR TY 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
{ } NAME(PRINT) J n C. Ma /
C TIME MONTH YEAR
SEAL SIGNATURE ~. DATE 02/23/200
MAILING ADQaE~S AM
'-v-I 20 MI ale , WappinQer Falls, NY 12590 02:47PM 02
STREET CrrYrrOWN STATE ZIP
~~~R~~Ri:~IO~O~~N~~~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 ~IL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 o OTHER, SPECIFY
24 2007
o 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
dge and belief that the information I provided is true and that I declare that no legal impediment exists
ClJ,uu?
DATE
by New York Domestic
MONTH
YEAR
04
24
2007
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY~U.~ /1. 0 !:.5
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF B-TOWN OF 0 VILLAGE OF
SPECIFY II In Il~ I ~ r
b_ 1/ I
NAME (PRINT)
SIGNATURE~