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COUNTY Dutchess
CITYrrOWN Wappinger
~~~~kc; 1368 .
~~~I~;~R 146
STATE OF NEW YORK
DEPARTMENT OF HEALTH
I
I
STATE FILE NUMBER
(TH/S SPACE FOR STA TE USE ONL Y)
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael Patrick O'Hare
MIDDLE CURRENT SURNAME
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Rebecca Rachael Lucas
MIDDLE CURRENT SURNAME
~
1 . A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
ll.
N
B. BIRTH NAME, IF DIFFERENT
B, BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE O'Hare
(OPTIONAL. SEE REVERSE) 112-76-3084
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r1 TOWN 0 VILLAGE
~~~CIFY East Fishkill
D. STREET ADDRESS 83 North Kensington Dnve ZIP 12t>::3::3
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES ~ NO
06 /28 /1'983
YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 1 33-72-8917
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinqer
D STREET ADDRESS 21 Maurice Drive
3. A. AGE 25
ZIP 12590
YES ~ NO
/ 1 981
38. DATE OF BIRTH
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
01 / 20
MONTH DAY
13. A. AGE 23
38. DATE OF BIRTH
YEAR
MONTH
DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Private Investiaqator
8. TYPE OF INDUSTRY OR BUSINESS A. I. S.
5. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE / COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Unemployed
8. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH PoughkeepSie, New Yark
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME John J. 0' Hare
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Geraldine A. Cipolla
B. COUNTRY OF BIRTH U S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
16. FATHER
A. NAME Charles L. Lucas
'8. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Deborah Lee Biddle
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DI'ifRCE CIVIL AN5ULMENT
DE'()H
DE6TH
B. HOW DID LAST MA'RRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 DIVORCE
B, HOW DID LAST MARRIAGE END?
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
C. DATE LAST MARRIAGE ENDED?
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 OECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
MONTH
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES
DAY
ONO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CIJY'COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
21. SIGNATURE OF GROOM ~
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
best of my knowledge and belief that the information I provided is tru~
./
RE OF BRIDE ~ '
o 0
o 0
o 0
o 0
al impediment exists
w
U)
Z
W
o
::;
USE CURR NT N ME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State of th authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New York S e. 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 CIIJ8ft~KC. Masterson 25. A SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
~
{ SEAL }
'-v-I
09/11/200
DATE
appinger Falls, NY 12590
TIME
MONTH
YEAR
MONTH
YEAR
09
12
2006
11
1 0 2006
AM
01 :28pM
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
CITYITOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
STATE
27. TYPE OF CEREMONY
o ~IGIOUS
9 0 OTHER, SPECIFY
ZIP
10 CIVIL
28, PLACE WHERE MARRIAGE OCCURRED
A, STATE NEW YORK B, COUN~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~;LLAGE OF
SPECIFY WItPP{~GeI?S !A-t.L--S
~G
TITLE
If. c. /tfl6r
4.yI: I', c2N0
1:2590
Z
31. WITNESS TO CER
STATE
NAME (PRINT)
SIGNATURE~