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Z 11:
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Robert Clayton Lyke
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYITOWN Wappinger
~~~~~c; 1368
~~~liJ~R 80
1. A. FULL NAME
FIRST
Q.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 050-76-8396
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A New York B. Dutchess
(STATE).J (COUNTY)
C. CHECK ONE 0 CITY l.J TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D. STREET ADDRESS 1 Pine I ree LJnve
1~oUj
ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES r5 NO
05 / 19 / 197
YEAR
3. A. AGE 28
3B. DATE OF BIRTH
MONTH
DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Pro Hockey Player
5. :~:::~:I:~US~~3g~~~~SpSI~,n~:~ ~~~~ey League
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Robert S. Lyke
U~A
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME Kathryn G. McConkey
U~A
B. COUNTRY OF BIRTH I
B. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO~CE CIVIL AN'tjLMENT
DE"Cr
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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 DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
Lo
SUPPLEMENTAL FILE
FROM THE BRIDE
Nicole Marie Paonessa
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Lyke
(OPTIONAL - SEE REVERSE) 131-60-5206
D. SOCIAL SECURITY NUMBER
12 RESIDENCEA. New York B. Dutchess
(STATE)..J (COUNTY)
C. CHECK ONe... 0 CITY LJ, TOWN 0 VilLAGE
~~~CIFY t-'oughkeepsle
L JaCKSOn unve - North 12603
D. STREET ADDRESS ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES ~ NO
13. A. AGE 28 3B. DATE OF BIRTH 12 /29 ~ 77
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Waitress / Bartender
uno Cnlcago Gnll
B. TYPE OF INDU&IflY OR ,BI,JSINESS N k
15. PLACE OF BIRTH t-'ougnKeepsle, ew yor
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A NAME Ralph C. Paonessa
. USA
B. COUNTRY OF BIRTH
17. MOTHER K F
aren arrey
A. MAIDEN NAME USA
B. COUNTRY OF BIRTH 1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL AN~LMENT
DEtfH
B. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
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) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 0 1ST 0 0
o 0 ~D 0 0
o 0 ~D 0 0
o 0 4TH 0 0
knowledge and belief that the information I provided is true and that I declare that no legal Impediment eXists
22. SIGNATURE OF BRID~ ./----O~/~4PYl.P..t:,,(;n
USE CURRENT NAME 06/26/2006-
DATE
SE CURRENT NA
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 CIT'Q~ C. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) a_ ~ 06/26/200
SEAL ~1~1~~~~d~apPlnger ralls~'lW lLo8U
'-.t-I .
STREET CITYrrOWN STATE ZIP
~~~R~~~Ri:J IO~O~~~NifE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 [;;YRELIGIOUS
DATE AND AT THE TIME AND AM
PLACE INDICATED. C. .30 PM 01 0 I OG. 90 OTHER, SPECIFY
~~~:i~9:~T ~~. A . .J . T 1Io^1<; 0 IV TITLE 7h e t e c../ e reAA
SIGNATURE~ .. A- A---d ~-DATE ISf- ~ Ot,
MAILING ADD~S~ . I, A '1.. 0
(2-- ~ V1, I~AAJ r A1:rz.- N '1 /2-5,/
STREET CITYITOWN STATE
30. WITNESS TO CEREMONY
'-f cQ..'( '2.Dto \ V\ ,:>ch'l
21. SIGNATURE OF GROOM'-
w
en
z
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o
::i
NAME (PRINT)
SIGNATURE~
bOH-98 (0312006)
by New York Domestic
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ULS. feR
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ef TOWN OF 0 VILLAGE OF
SPECIFY IN esT f r.::ti<K-
NAME (PRINT)
SIGNATURE~