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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Daniel Nathan Porter
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I, being duly sworn, depose 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 m~rriage s~ate. ~ ~ ~ j,;-"'J
21 SIGNATURE OF GROOM ~ 22 IGNATURE OF BRIDE ~ ./ ~ ~ ~~
././ USE CURRE 05I15l2OO6
23 SUBSCRIBED AND SWORN TO BEFORE ME ' .;'
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York Sta of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within ew 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 C~'n"t.;M-+-"''''''' 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME(~RINT) . ~.~.
{SEAL ." .~....,," 05f1512OD6 TIME MONTH DAY YEAR MONTH DAY
SIGNATURE ~ ".~__. -- DATE Oil 14 2006
'-.y-I M2f)I - ppI ails, NY 12590
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICAr~D.
COUNTY~
CITYrfOl{i~PPnger
DISTRICi)
NUMBER
REGISTER!)2
NUMBER
1. A. FULL NAME
FIRST
MIDOLE
CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
0-
N
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REvERSE()Q3-12-5192
2 :ES~:EC~~~ :E~ey;'8~ B. DUtCheSS
(STATE) " (COUNTY)
C. ~~5CK Otvapp~FiI~ 0 VILLAGE
SPECIFY 14A. Franldln Str~
D. STREET ADDRESS ~
E. IS R~~NCE WITHIN LIMITS OF CITY OR INCORPORATE'ifl^GE? 1\1\ 0
3. A. AGE': 3B. DATE OF BIRTH ~
MONTH DAY
4. EMPLOYMENT J 01 Correcti Offi
A. USUAL OCCUPATION went e an 0 .cer
5. :~::~~:I::J~~'rW~b':~~':- lork
(CITY, STATEiCOUNTRY IF NOT USA)
6. FATHER stephen W Porter
A. NAME 0
8 COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Susanne E. swanson
8 COUNTRY OF BIRTH U ~ A
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVtfCE CIVIL A'6'ULlMENT
DtiTH
11. A.
L 0 SUPPLEMENTAL FILE
FROM HIE BRIDE
Jacqueline Ann Me court
FULL NAME
FIRST MIDDLE
CURRENT SURNAME
12580
Y/i91~
YEAR
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B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. BIRTH NAME (MAIDEN NAME),t5afNT
C S~~~6N~~~~~t~~e~~SE~20-72-9490
D. SOCIAL S~Tdfk DIJlChess
12. RESIDENCE A. B.
(STATE) (COUNTY)
C. ~~5CK ~ppUl~ '8liN 0 VILLAGE
SPECIFY 14A Franklin Street 12S90
D. STREET ADDRESS 'f1
E. IS R~NCE WITHIN LIMITS OF CITY OR INCORPOR^MVILLAG~ 0 1~ NO
13. A. AGrf-~ 13.B. DATE OF BIRTH --
MONTH DAY YEAR
14. EMPLOYMENT Resjs'terd Nurse
A. USUAL OCCUPATION VtDS81 Blott.er5
B. TYPE OF INDlollIm".QIil.~ L-&.-__ . . k
....DUW'I~.,. ...,.. 1 UI
15. PLACE OF BIRTH
(CITY. STATEiCOUNTRY IF NOT USA)
16. FATHER John Me Court
A. NAME USA
B. COUNTRY OF BIRTH
17. MOTHER Jacqueline Irene S81aun
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
DtjORCE CIVIL A'trULMENT
DrtTH
YEAR
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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S, HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
YEAR
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
YEAR
ZIP
CITYITOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
1';& CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNTY \J\I~~W
NAME (PRINT)
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~ ~~~ti~~~1.,.. H~~. JAMES D. P.~~GONES TITL ( :\
~ "0"""; ~_ ~ OA" ~ )"..... 3, 20010
Ii: CI~G('~:~. \0 N\o.r~ S ('~:\) ()o\J~~u.oS\C1..} N~ \2.~\
W STREET ' CITYfTOWN ~ STATE" ZIP
o 30. WITNESS TO CEREMONY 31. WITNESS TO CEREMONY
--
NAME (PRINT) ...)
SIGNATURE ~
DOH-98 (11/98)
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY ~~~ '? o..\~