075
Dutchess
COUNTY
wappinger
CllYJroWN
0lS11lICT 1368
~75
NUMBBI
STATE OF NEW YORK
OEPARTMENT OF HEALTH
AFFIDAVIT, UCENSE and
CERTIFICATE OF
MARRIAGE
FROM lHE GROOM
James P Trainor
cMlDDI.e cu_ SIJRN;WE
r
STATE FILE NUIlBER
(THIS SPACE FOR STATE USE ONLY)
I
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o SUPPLEMENTAL FILE
FROM THE BRIDE
Miiia K. LeSIfARENTsullNAME
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1. l'.. FUU.. NMIIE
11. A. Rill. NAME
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6. FAmER
A. NAME James A. Trainor
B. COUNmYOF BlmH USA
B. BUml NAME (UAlDEN NAME). IF DJFFEIIEHT
C. ~~ERSE} TFaiAer
o. socw.SB:URI1YNIJMIlER 06772 1074
12. RESlDENCEA. N--.1or:k B. ~ss
C. CHECKONE 0 CITY [VTOWN 0 VlUAGE
~ Pnllghkt"ep,ie
o. SfREET ADDRESS 26fifi Wp.m MAin ~reet ZIP 1259g
E. IS IlESIIlENCE WI1HlN lJMfl1l OF CITY OIllNCORPORATED VlUAGE? ~ YES 0 NO
13. A. AGE 32 3B. DATE OF BIRTH ~ / 0$ /.Ii1A
1-1. BIPtOYMENT
A. USUAl.. OOCUPAllON Teacher
8. TYPE OF INDUSTRY OR BUSINESS Hyde Part CRtr:l Sehl Dist
15. PLACE OF BIRTH Kinomnn New yO....
(CITY. ii'fATE I iXXiNiilY IF NOT U~
16. FATHER
A. NAME Th()P18S Losee
B. OOUNTRV OF BIRTH I J ~ ".
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B. BIRTH NAME, IF DIR'BIerr
c. SlIRNAMEARER MARRIAGE
(OI'1IONAl 0 SEEREV6RSEl 094-66-7376
D. llOtW.SECUIII1Y NllMI!Bl
2. iRESIDBICEoIl New York B. Dutchess
(STAlE)..J (COIlIoRY)
c. =:: Pou~hk:;eps~OWN 0 VI!JAGE
D. SlREfl.ADDRESS ilti68 West MaIn Street 711' 12590
E. IS RE!SlIBlClE wrmw UMffS OF CITY OR lNCORPORA1EB VlUAGE? r:f YES D NO
S. IA. AGE 31 3B.Dl\lEOF8lR1l1 09 /'4 / 1Q14
MOIllH OA.Y -
4. BM'I.OVMENT
A. USUAtOOCUPATION Teacher
5. :"==OFOF"::lJi1b:nY:~ ~~ C. Ketcham
(OITY. STAlE./OOllNlftV IF NOT ~
9. PREVlO\JS MAAAlAGES
iA.l\IlJMBER OF PREVIOUS MARRIAGES WHICH sma> BY
~ OIVlLo-m
17. MOlHEfI
A. MAIDEN NAME CArn' VAnn
B. COUNTRY OF BIRTH I J ~ A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DEAlH DIVORCE CIVIL ANNULMENT
o 0 0 0
B. HOW DIIHASTNABRIAGE END'! ~) 0 D1l1ORCElB) 0 ~ (2l D OEAlH B. HOW 00 lAST UARIlIAGE END'! (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEAlll
C. DAn: lAST IlIAHRlAGE ENIJEO? / / C. DATE l.AST MAftRII\GE ENDED? / /
_ ato.v ~ MONIH DAY
0. ARE ANV FORNIER SPOUSE(S) ALIVE? IJ YES 0 NO Do ARE ANY FORMEA SPOUSE(S) AUVE? 0 YES 0 NO
lC. iF iPREVIOOSLY OIVORCEO OR ANNuu.ED.. PROVIDE 1HE ,R)U1)WING lNFORMAllON 20. IF PREVIOUSLY DIVORCED OR ANNUu.ED. PROVIDE THE FOLLOWING INFORMAllON
DAlE OF !DECREE PlACE ISSUED AGA1NST WHOM DAlE OF DECREE PlACE ISSUED AGAINST WHOM
(MOMThI. Oll.V. 'VEAI!I1 (ORYIOOONlY. S'l"A1Eall:INmV.lFtlOHlSAj SElF SPOUSE (MON11i. DAY. VEAR) (ClTYICOllNTY. STATEICOUNTRV.IF NOT USA) SELF SPOUSE
1ST 0 0 1ST 0 0
2ND 0 D 2ND 0 0
3R00 .0 3RD 0 0
41H 0 D 4TH 0 0
l duly ~al'firm. GeP.ose an $8Y that m ttle~. jls!: 01 my ~e and beliellhat tbe infonnaIion I provided is t.rue~decI_ are. that~legal j iment exists
as to my ftghtm enter tnto the gestate. ~ ..... - V
21. 9IGNATlJIIE OF GROOM. ..... 22. SIGNATURE OF BRIDE. 'A.) ~ / P
. USE 'aJIIl~ '-'
23. 'SllBSORlBEDJIND SWORN ml FIRMED BEFORE U
'SIGNATURE 'OF :rowNCR cnv CLERK.
This 1iD8llSll authorizes tile mBfri9 in New Slate of bride and groom named above by any person authorized by New York Domestic
Relations iLBw ~H to petfoml marriage mremDnies wilhin New YOlk Stale. THIS UCENSE VAUD IN NEW YORK STATE ONLY.
o If d.IeOked. Ibis lioanse is m be used only for tbe purpose of a second or subsequent ceremony.
~ 24. TOWN OR 0llV ~ 25. A. SOJ..BaNIZAllON PERIOD BEGINS
} 'NA'ME'(PRINT). ,",onn l,;. Masterson
{SEAL SIGNATURE. DAlE 06116/2006 TIME MONTH YEAR MONTH
"-v-' N2rrMRft1 sh Rd, ppin er Falls NY 12590 17 2006 8 15 2006
'STREET ClTYITOWN STAlE ZIP
'~~~':R~: '~~~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS :NAMED ABOVE 'ON :r.IiIE tile. DAY. ~EAR D ~ RELIGIOUS
!DATE ,A"ND ,AT 1I11E TIME AND
'PLACEINDIOATED. 'lIJ)/, , 90 OTHER. SPECIfY
DEAlli
"I. MOTHB'l
A UAIDEN NAME Susan A. Lafontaine
B. COlJN'IRV OF 9lR1H USA
8. NUMBBUJFTlflSMARRlAGE 1
YEAR
DAlE
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VEAR
1 0 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STAlE NEW YORK B. COUNTY U ( '1er
C. LOCATION OF CEREMONY
(CHECK ONE AND SPEClFVj
o CIlY OF 0 TOWN OF Hf VIUAGE OF
SPECIFY u)tA-tlK,'1f
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29. OFFlCI"NT
,NAME '(PRINT)
ll'H.E "e..v~d...
DATE (pI "l.ll/ (.()o(.
AfY
STAlE
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SIGNATURE.