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COUNTY Dutchess
CITYfTOWN Wappinqer
~~~:~c; 1368 .
~~~I:~~R 181
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Frlwarrl Ru!';!';ell Stroman
MIDDLE CURRENT SURNAME
lilAIt: t"IL~ NUMIS~11
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Lisa Maire Nelson
MIDDLE CURRENT SURNAME
-.J
1 . A. FUll NAME
11. A. FUll NAME
FIRST
FIRST
Q.
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Nelson-Stroman
(OPTIONAL' SEE REVERSE) 081-46 3992
D. SOCIAL SECURITY NUMBER -
12. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN cY' VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDRESS 2 Fulton Street; Apt 2 ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
03 /31 /4963
MONTH DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 115-42-2848
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B. l1utchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN r51 VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDRESS 2 Fulton Street: Apt 2
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE FiFi 3B. DATE OF BIRTH 04 /
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION I Jnemployerl
B. TYPE OF INDUSTRY OR BUSINESS
5. PLACE OF BIRTH Beacon New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME r.h::!rle!'; r. Strom::!n
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Harriet Mime
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
ZIP 12590
cY' YES 0 NO
OR / 1QFi1
DAY YEAR
3B. DATE OF BIRTH
13. A. AGE 4~
14. EMPLOYMENT
A. USUAL OCCUPATION Unemployed
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Sharon. Connecticut
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Merton E Nelson
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Lillian F. Pennacchio
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 1
DEATH
o
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
9. ~~~~~~~R~f~~~T8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) ~IVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 08/ 27 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? Oo,(ES 0 NO
1D. 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
08/27/1979 Poughkeepsie. New York aI 0 1ST
o 2ND
o 3RD
o 4TH
e Ie that the information I provided is true and that I
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.'- YEA
(2) 0 DEATH
1979
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. PROVID THE FOLLOWING IN ORMATION
DATE OF DECREE PLACE ISSUE AGA ST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATElCOU SE SPOUSE
1ST
2ND
3RD
4TH
I duly swear/affirm, dep.ose and say, that to the best of my kn
as to my right to enter into the mam .
21. SIGNATURE OF GROOM~
2 IGNATURE OF
U C
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New Yo State of the bride and groom named above by any erson au
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 cererri ny. / r
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PER EGINS
NAME (PRINT) ohn C. Master
York Domestic
~
{ SEAL }
~
MONTH
YEAR
YEAR
~-
TIME
MONTH
DATE 12/05/200
in er Falls NY 12590
CITYITO STATE ZIP
26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY \
TIME MO. DAY YEAR DR RELIGIOUS 1 0 CIVIL
AM
PM & ( 9 0 OTHER, SPECIFY
SIGNAl'URE ~
MAILING ADDRESS
20 Middle
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
02:5&M
03 2007
06
2006
02
12
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEWYORK B.COUNTY t>~tt-k~?S
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF 18 VILLAGE OF
SPECIFY~~f Y'J.e'{'J f'V\ ( {5
29. OFFICIANT
NAME (PRINT)