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COUNTY Dutchess
CITYfTOWN Wappinqer
~~~:~c: 1368
~~~I~~~R 1 30
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
-.J
FROM THE BRIDE
1. A. FULL NAME Steven Robert Whltnev 11. A. FULL NAME Patricia Anne Reidy
FIRST MIDDLE CUR'RENT SURNAME FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME, IF DIFFERENT McKp.nn8 B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Sca rry
c. SURNAME AFTER MARRIAGE C. SURNAME AFTER MARRIAGE Reidy - Whitney
(OPTIONAl- SEE REVERSE) (OPTIONAL' SEE REVERSE) 064-66-3486
D. SOCiAl SECURITY NUMBER D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. New York B. Dutchess 12. RESIDENCE A. New York 8. Dutchess
(STATE) (COUNTY) (STATE) (COUNTY)
C. CHECK ONE 0 CITY r!f TOWN 0 VILLAGE C. CHECK ONE 0 CITY cf TOWN 0 VILLAGE
~~~CIFY Wappinqer ~~~CIFY Wappinger
D. STREET ADDRESS 5 Wildwood Drive, # 8 A ZIP 12590 D STREET ADDRESS 5 Wildwood Drive, # 8 A ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES d" NO E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlLAGE? 0 YES c'1 NO
01 / 31 / 1977 13.A. AGE 39 3B. DATE OF BIRTH 10 /03 /1966
MONTH DAY YEAR MONTH DAY
3. A. AGE 29
3B. DATE OF BIRTH
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Security
B. TYPE OF INDUSTRY OR BUSINESS
5. PLACE OF BIRTH Northampton, England
(CITY, STATE I COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Collector
B. TYPE OF INDUSTRY OR BUSINESS Prof. Recoverery Group
15. PLACE OF BIRTH Bronx, New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Patrick J. Scarry
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Eileen Malone
B. COUNTRY OF BIRTH U S A
2
18. NUMBER OF THIS MARRIAGE
6. FATHER
A. NAME Michael McKenna
B. COUNTRY OF BIRTH England
7. MOTHER
A. MAIDEN NAME Pamela Maureen Webster
B. COUNTRY OF BIRTH En,land
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV~RCE CIVIL AN~LMENT
.,.
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 06rrULMENT db9 DEATH
C. DATE LAST MARRIAGE ENDED? 02 / / 2
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
(~J:tTJ;l,,Of,"'"tFAfY .. \CITY/yOlJNTY, StJATE/c;QUNTRy.1f NOT USA) SELF SPOUSE
UL/UflLUU') vveSIcnes er ~o., I'lIew 0'" 0
o 0
o 0
o 0
gal imped' ent exists
DEATH
o
DE'(fH
YEAR
MONTH DAY
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) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
of my knowledge and belief that the information I provided is
21. SIGNATURE OF GROOM~
23. SUBSCRIBED AND SWORN TO/AFFIRMED 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 CITYJCUORK C M t 25 A SOLEMNIZATION PERIOD BEGINS
onn . as erson . .
NAME (PRINT)
York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
~
{ SEAL }
'-v-I
YEAR
MONTH
DAY
YEAR
08/23/200
DATE
ails, NY 12590
10
22 2006
ZIP
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
o 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 INDIC
28. PLACE WHERE MARRIAGE OCCUR~ .. _A
A. STATE NEW YORK B. COUN~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) ./
o CITY OF 0 TOWN OF ~LLAGE OF
s~~/~ ~
SIGNATURE ~
MAILING AD
NAME (PRINT)
SIGNATURE~