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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
A_....FROMIIJHE .GROOM
I"\llUIewWl lam Downing
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
Dutchess
COUNTY We~nger
CITYfTOY1'388
DISTRICT
~~~I~~R 24
NUMBER
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
FULL NAME Erin Mary Glendenning
FIRST MIDDLE
CURRENT SURNAME
1. A. FULL NAME
11. A.
FIRST
MIDDLE
CURRENT SURNAME
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B. BIRTH NAME (MAIDEN NAME), ~T
C. SURNAME AFTER MARRIAGE ng
(OPTIONAL - SEE REVERSE)120-rL-2194
D. SOCIAL S~ITY NUMI!IiB
12. RESIDENCE A. assacnusetlS B. WOrcester
(STATE)~ (COUNTY)
C. ~6CK ~i TOWN D VILLAGE
SPECIFY 48 El:I5l Gardher RDBd
D. STREET ADDRESS
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE D4~L '91'L __~
(OPTIONAL - SEE REVERSE .,. I ",,,;:1 I ~
D. SOCIAL SE'Mii!JIl:hl.ll!ldlbt vvorcester
2. RESIDENCE A. (STATE)'; B. (COUNTY)
C. CHECK 0NEa~-&:I..~ TOWN D VILLAGE
AND "VvaHJJlIJDlC'I
SPECIFY 48 ~ast Gardner Road 61473
D. STREET ADDRESS ZIP .;
E. IS R~CE WITHIN LIMITS OF CITY OR INCORPORATE~GE? A2D YES ~~
3. A. AGE 3B. DATE OF BIRTH L ~
MONTH DAY YEAR
4. EMPLOYMENT Engineer
A. USUAL OCCUPATION Turbosteam
B. TYPE OF INDl(JfOt&f.UC6h'hedlcut
5. PLACE OF BIRTH
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER Glenn Downing
A. NAME USA
B. COUNTRY OF BIRTH
Zlp01473
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E. IS RE:I)NCE WITHIN LIMITS OF CITY OR INCORPORAl~VILLAGEPa D 1~ NO
13. A. AGE 13.B. DATE OF BIRTH
MONTH DAY YEAR
14. EMPLOYMENT M - M
alMRIng an&ger
A. USUAl OCCUPATION W. R G
B. TYPE OF INDu.ltl SI.u;~ . '. . Rice
15. PLACE OF BIRTH ~1IIn5. New IDl'k
(CITY, STATElCOUNTRY IF NOT USA)
16. FATHER K neth B . GI den'
A. NAME en nan en mng
B. COUNTRY OF BIRTHU 6 A
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17. MOTHER
A. MAIDEN NAME Mary Margaret Madden
B. COUNTRY OF BIRTtFS"?
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DOORCE CIVIL ArrULMENT
7. MOTHER Noreen Theresa Taylor
A. MAIDEN NAME. USA
B. COUNTRY OF BIRTH 1
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DlVErCE CIVIL A't)'ULMENT
DftTH
DtiTH
B. HOW DID lAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(2) D DEATH
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) D ANNULMENT
/ /
(2) D DEATH
(3) D ANNULMENT
/ /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, at
as to my right to enter into the marri e S
21. SIGNATURE OF GROOM ~
D 1ST D D
D 2ND D D
D ~D D D
D 4TH D D
belief that the information I provided is true and that I declare that no legal impedim nt exists
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SIGNATURE OF BRIDE ~
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23. SUBSCRIBED AND SWORN TO BEFORE ME.
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York Sta person authorized by. New York Domestic
Relations Law l/11 to perform marriage ceremonies within ew York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
D If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR ~e. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{~} ~~~iIB.~"~
STREET CITYITOWN STATE ZIP
~~~R~:Ri~~~ IO~O~~~N~zEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED A80VE ON THE TIME MO. DAY YEAR o)lt RELIGIOUS 1 D CIVIL
DATE AND AT THE TIME AND 6
PLACE INDICATED. }f((1I. 'Z. '1.,1..00 9 D OTHER, SPECIFY
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTJ)\1T"c.+I~SS
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF lS..,TOWN OF D VILLAGE OF
SPECIFY ~A$-r rl S H Kt 1-1-
29. OFFICIANT (
NAME (PRINT)
TITLE f<. t::. PR tg oS,
~ DATE APt\U... 2-21200b
~TYfT~1< tf1.8, HlIr(W~~;TE JG~ NY I~S~~
31. WITNESS ~!R..E~ONY r--:.
NAME (PRI~~ {~C. Co..... A': v...s CO
SIGNATURE~ ~ Q ~AM dI~
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
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