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COUNTY Dutchess
CITY/TOWN Wappinger
~~~:~c: 1 368
~5~1~~~R 149
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Thomas Gerard O'Connor
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPAC}.E FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
-.J
1 . A. FULL NAME
FROM THE BRIDE
Kathrvn Lvnn Leonard
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT B ru e n
c. SURNAME AFTER MARRIAGE O'Connor
(OPTIONAL. SEE REVERSE) 118-58-1595
D. SOCIAL SECURITY NUMBER
12 RESIDENCEA. New York B Dutchess
(STATE) (COUN1Y)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 5 Wildwood Drive, Unit 5 D ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES d" NO
09 /13 /f961
DAY YEAR
11. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 111 58-8479
D. SOCIAL SECURITY NUMBER -
2 RESIDENCE A New York B. Dutchess
(ST ATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wqppinger
D. STREET ADDRESS 5 Wildwood Drive, Unit 23 Q 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
07 / 16 / 1959
MONTH DAY YEAR
13. A. AGE 44
3. A. AGE 47
3B. DATE OF BIRTH
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A USUAL OCCUPATION Retired
B. TYPE OF INDUSTRY OR I;lUSINESS
5. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE / COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Recruiting Supervisor
B. TYPE OF INDUSTRY OR BUSINESS Kohl's
15. PLACE OF BIRTH Mount Kisco, New York
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Robert Eugene Bruen
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Marie Althea Pappas
B. COUNTRY OF BIRTH USA
2
18. NUMBER OF THIS MARRIAGE
6. FATHER
A. NAME James O'Connor
B. COUNTRY OF BIRTH Ireland
7. MOTHER
A. MAIDEN NAME Mary Joan Fahy
B. COUNTRY OF BIRTH Ireland
8. NUMBER OF THIS MARRIAGE 2
+
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19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) cYolVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) O~IVORCE (3) 0 ANNULMENT (210 DEATH
C. DATE LAST MARRIAGE ENDED? 11/ 24 / 1992' C. DATE LAST MARRIAGE ENDED? 03 / 06 / 20uo
MONTH J DAY YEAR MONT':!..I DAY' - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? [J YES 0 NO
~
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH, DAY, YEA~ (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
11/24/1992 Poughkeepsie, N Y 0.... 0 1ST 03/06/200u Poughkeepsie, New York 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 t~u~at I declare that .no lega~impediment exists
22.SIGNATUREOFBRIDE~' ~'1--..--r~~C~
~ ruSE CURRENT NAME
DATE 09/12/2006
by New York Domestic
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
DEATH
o
DEATH
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USE CU
23. SUBSCRIBED AND SWORN TOI FFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY 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 CIJ'6h~ 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
09/12/200 TIME MONTH YEAR
SEAL SIGNATURE ~ DATE
'- -.J MAI~ 'tOO~dfeb sh Rd, Wappinger Falls, NY 12590 AM 09
-v- 03:16pM
11
11 2006
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
DAY
YEAR
MONTH
13
2006
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
CITY {TOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
STATE
27. TYPE OF CEREMONY
~ELlGIOUS
9 0 OTHER, SPECIFY
ZIP
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY.DoRttr~
29. OFFICIANT
NAME (PRINT)
~~\C~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF.~N OF 0 VILLAGE OF
SPECI:V?;' U 64 KflP<:;l ,q:
SIGNATURE ~
MAILING ADDR
slJl f:;i)LL~r
30. WITNESS TO CEREMONY
NAME (PRINT)~i."
SIGNATURE~' /4:..
DOH-98 (0312006\
..gATE ()
Gh14tff./- j.J V (' OS!?-
TATE ' / ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) ~ ~
SIGNATURE~ d
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