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~~~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
William G Gardner. II
MIDDLE CURRENT SURNAME
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
~ 0 0 ~ 0 0
4TH 0 0 4TH 0 0
I duly swear/affirm, dep'ose and say. that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the mam ge state. _ ./ ~ ... "~
21. SIGNATURE OF GROOM; '. ~~ 22.SIGNATUREOFBRIDE~ ~ . "uJ.IM1ft
us N us CURRE AME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME 08/09/2006
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New State he bride and groom named above by any person authorized by New York Domestic
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.
r-I'-.. 24. TOWN OR CIl) C ERKC. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
08/09/2006 TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ DATE
'-v-I MAI~ M appinger Falls, NY 12590 03:46:~ 08 10 2006 10 08 2006
STREET CITYITOWN STATE ZIP
~~~R~~RT~~~ 10~0!t.~N:.zEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 00 RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. $:0" }f)()~ 90 OTHER, SPECIFY
COUNTY Dutchess
CITY/TOWN Wappinger
~~~~~: 1368 .
~~~:~R 118
1 . A. FULL NAME
FIRST
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
"I
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 086-72-5311
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NV B. Clark
(STATj:) (COUNTY)
C. CHECK ONE ~ CITY 0 TOWN 0 VilLAGE
~~~CIFY North Las Va-.9as
D. STREET ADDRESS 2616 Bed Knoll Court ZIP 89031
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? dYES 0 NO
3. A. AGE 30 3B. DATE OF BiRTH 06 / 28 / 1 976
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Telecommunications
B. TYPE OF INDUSTRY OR BUSINESS Telecommunications
5. PLACE OF BIRTH Mccandless T ovmship
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME William G. Gardner
B. COUNTRY OF BIRTH U S A
7. MOTHER
A. MAIDEN NAME Marlene H. Schmid
B. COUNTRY OF BIRTH U S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVOOCE CIVil ANOLMENT
DE'3H
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kristin Marie Greene
MIDDLE CURRENT SURNAME
-.l
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEAJH
11. A. FULL NAME
FIRST
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) (CITYICOUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Gard ner
(OPTIONAL - SEE REVERSE) 127-72-8337
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. NV B. Clark
(STA!g) (coUNTY)
C. CHECK ONE I!I CITY 0 TOWN 0 VilLAGE
~~~CIFY North Las Vagas
D. STREET ADDRESS 2616 Bed Knoll Court ZIP 89031
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? tJ YES 0 NO
04 /10 /1'978
DAY YEAR
13. A. AGE 28
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Therapist
B. TYPE OF INDUSTRY OR BU~INESS Health Care
15. PLACE OF BIRTH OgdensDurg, New York
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Michael Francis Greene
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Emma Grace Beaulieu
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D1'tfRCE CIVil AN~ULMENT
DE~TH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
,,- 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, PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
1 0 CIVil
A. STATE NEW YORK B. COUNTY'7u1 ;WJ)
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~ VilLAGE OF
TITLE
SPECIFY Co!d, 9s /- /...H4
'J
SIGNATURE