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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
3t_en MichadoSulli\"'8fl CURRENT SURNAME
1 g
B. HOW DID lAST MARRIAGE END? (3)Wl DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE lAST MARRIAGE ENDED? 1" / .. 0 / .,nn1 C. DATE LAST MARRIAGE ENDED? n6 / 15 /1999
MONTH IE: oW ~ MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? ~YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
12/1912001 pOl:Jghkeepsie, N y ~ 0 1ST 06/15/1999 pougbkeep~iflo. N v 0 ~
o 0 2ND 0 0
o 0 ~D 0 0
o ~H 0 0
lief that the information I provided is :;:;r:d tit I declaretha~t no legal impediment exists
~. """""'"' OF GROO"~. & ". "G",~", 0' OR'"~ ~ /1:..'1 p
23. ~~~..fT~~~Oo~N.fo~~06'~ d;~Bg~~ ~ E ATE 04/1212006
This license authorizes the marriage in New York State of the 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.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
COUNnoutchc33
g:~~2TW"'.'V8ppiflgcr
NUMBER~ ~6B
REGISTE
NUMBER 27
1. A. FULL NAME
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B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 116-62-8510
2. RESIDENCEA'N "TATEI B. D~SS
C. ~6CK ONE 0 CITY,jJ TOWN 0 VILLAGE
SPECIFY pOl:Jghkeepsic
D. STREET ADDRESS41 ReDiA Read ZIP 12601
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES.{J NO
JlOH /1 &Y /1~62
3. A. AGE43
4. EMPLOYMENT
3B. DATE OF BIRTH
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A. USUAL OCCUPATION Truck Driver
B. TYPE OF INDUSTRY OR BUSINESS WRite Plainllinen
5. PLACE OF BIRTH"""~~_X.
6. FATHER
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A. NAME Rithard Patrick Sulliwfl
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Helen MMgaret Schfleider
8. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
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{ SEAL }
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NAME (PRINT)
SIGNATURE ~
MAILING ADDRESS
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. FULL NAME 6ar:\1lfa E rlK e~LE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENTMc5bane
c. S~S~~~JN~FC~~~t~~e~~~~llivan
D. SOCIAL SECURITY NUMBER -u9a.-52-2?~5
12. RESIDENCE AN ~STATE) B.~~~~
C. CHECK ONE 0 CITY il!!l TOWN 0 VILLAGE
AND ....n bk .
SPEChr-OUg ~eple
D. STREET ADDRES~ Pt,yllis Road ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
13. A. AGF4'" 13.8. DATE OF BIRTH 1 n as 19SR
.,. -----miNTH DAY 'l{EAR
14. EMPLOYMENT
A. USUAL OCCUPATION Speech P~hnlngi~
B. TYPE OF INDUSTRY OR BUSINESSSelf-employed
15. PLACE OF BIRT~WJ,~mm~N~~Xg~
16. FATHER
CURRENT SURNAME
A. NAME James A McSb~nflo
B. COUNTRY OF BIRTt-J,p-IAnd
17. MOTHER
A. MAIDEN NAME Catherine A Kelly
B. COUNTRY OF BIRT.... I 5 A
18. NUMBER OF THIS MARRIAGE 2'
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 n
DEATH
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25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
DATE 04/1Z12D06
TIME MONTH DAY YEAR MONTH DAY YEAR
AM 13 2006 06 11 2006
PM 04-
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY 7Ju..f-ti..t J
ZIP
ST
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
OATE AND AT THE TIME AND
PLACE INDlCATEO.
, A
27. TYPE OF CEREMONY
O~ RELIGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
29. OFFICIANT
NAME (PRINT)
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
C. L!?CATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~ VILLAGE OF
",C,,, LA>>rf I<<) Us bJ-t s
ZIP
,,. WIT",'" ~" /
/ NAME (PRINT) ~ n~.5f1lA^
SIGNATURE~ tJ-..