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COUNTY Dutchess
CITYrrOWN Wappinger
~~J:~ 1368 '
~5~~~R 114
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
James Mannina Cook. JR.
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kristine Marie Howard
MIDDLE CURRENT SURNAME
~
1 . A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 258-49-6231
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE).J (COUNTY)
C. CHECK ONE 0 CITY C'J TOWN 0 VILLAGE
~~CIFY WapQinger
D. STREET ADDRESS 5 Pembroke Circle, Apt D ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 VES t1 NO
3. A. AGE 27 3B. DATE OF BiRTH 04 / 20 / 1979
MONTH DAY YEAR
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Cook
(OPTIONAL - SEE REVERSE) 076-66-6306
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. NY B. Dutchess
(STATE)..J (COUNTY)
C. CHECK ONE q CITY L:J TOWN 0 VILLAGE
~~CIFY Wappinger
STREET ADDRESS 5 PembroKe Circle, Apt U ZIP 1 ~o~u
IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 VES ~ NO
03 /09 ,11979
DAY YEAR
D.
E.
13. A. AGE 27
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUllTflY OR BUSllljESs.. ,orange Ulster IjOG!::::>
15. PLACE OF BIRTH Newburgn, New York
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Robert James Howard Jr.
'B. COUNTRY OF BIRTH U ::> A
17. MOTHER O'S II'
A. MAIDEN NAME Maureen u Ivan
B. COUNTRY OF BIRTH U ::> ~
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL AN~LMENT
...
:>
c
Q
u:
u.
C
4. EMPLOYMENT
A. USUAL OCCUPATION Sergeant
B. TYPE OF INDUSTlRY OR BUSI~SS United States Manne Corps
5. PLACE OF BIRTH Atlanta, (,jeorgia
(CITY, STATE I COUNTRY IF NOT USA)
B. FATHER
A. NAME James Manning Cook
B. COUNTlRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Marcia Diane Hoyt
B. COUNTRY OF BIRTH USA
1
8. NUMBER OF THIS MARijlAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D1VOBCE CIVIL AN"tjLMENT
DEfr
DE"cf
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
,-~ YEAR
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) (ClTYICOUNTY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
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, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
o 0 1fi 0 0
o 0 2ND 0 0
o 0 ~D 0 0
o 0 4TH 0 0
y knowledge and belief that the Information I provided Is :rue j"l ~at I declare tha~~ I~gallmpediment exists
- 22.SIGNATUREOFBRI~~ ~~ ~
USE CURRENT NAME 08/02/2006
DATE
by New York Domestic
1ST
2ND
3RD
4TH
I duly swear/affirm, aepose and say,
as to my right to enter Into the mama e
21. SIGNATURE OF GROOM~'
USE
23. SUBSCRIBED AND SWORN TOIAFFIR BEFORE ME
SIGNATURE OF TOWN OR CITY CLE ~
This license authorizes the marriage in New State of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonias within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used onl for the urpose of a second or subsequent ceremon .
~ 24. TOWN OR C~81iPf C. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
TIME MONTH YEAR
SEAL SIGNATURE ~
'-v-' MAI'l{9 tmEMle 12590 04:4~~ 08 2006
. STREET CITYITOWN
~~:~~R~~J IJO~~N::~ 28. SOLEMNIZATION OCCURRED
SONS NAMED ABOVE ON THE ME AY YEAR
DATE AND AT THE TIME AND A
PLACE INDICATED. M
MONTH
YEAR
10
01 2006
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
ZIP
l~L
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY~"~D~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WN OF 0 VILLAGE OF
SPECIFY!A1 f t j /.. j -e r
29. OFFICIANT
NAME (PRINT)
SIGNATURE~