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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
James John Turner
FIRST MIDDLE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
COUNTY Dutchess
CITYfTOWN WeDDlnaer
~tfJ~kc~ 1368
~5~I~J~R 1
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. . FULL NAME Crystal Jaj Cole
FIRST MIDDLE
CURRENT SURNAME
CURRENT SURNAME
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B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE~ ~ ~ nn58
D. SOCIAL SECURITY NUMBER ~
2. RESIDENCE A. New Vark B Dutchess
(STAm (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFY WaDDinaers Falls
D STREET ADDRESS 36 North Gilmore Boulevard ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
11 /23 /1977
MONTH DAY YEAR
B. BIRTH NAME (MAIDEN NAME), .IF DIFFERENT
C. SURNAME AFTER MARRIAGE Tumer
(OPTIONAL - SEE REVERSE)~~~ ~ ACX!n
D. SOCIAL SECURITY NUMBER ~
12. RESIDENCEA.NAwltVark B. Dutchess
. --l's'htE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~cIFYWaDDinaers Falls
D. STREET ADDRESs36 North Gilmore Boulevard ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
13. A. AGE27 13.B. DATE OF BIRTH 02 fl 1978
MONTH DAY YEAR
3. A. AGE28
3B. DATE OF BIRTH
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4. EMPLOYMENT
A. USUAL OCCUPATION Self Emploved
B. TYPE OF INDUSTRY OR BUSINESS landscaping
5. PLACE OF BIRTH Pmdl~e. New' York
. (CiTY.~A;'EiCod'NTRy IF NOT USA)
6. FATHER
A. NAME steDhen John Tumer
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Msrllynn Ann large
B. COUNTRY OF BIRTH U S A
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS JMsh Comm. Center
15. PLACE OF BIRTHMrwIn. CoIOI'8do
.~:1;;'ArE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Thomas John Cole
B. COUNTRY OF BIRTJJ S A
17. MOTHER
A. MAIDEN NAME G-.yIe Gelbmsn
B. COUNTRY OF BIRTJJ S A
1B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
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DEATH
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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 ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION I
(rJtJfH~tifi.C:EFfR) (CITY, STA/~gD~~~~~?F NOT USA) A~t~~S~p~~~~ f
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1ST
2ND
3RD
4TH
I, being duly sworn, depose and
as to my right to enter into the m
21. SIGNATURE OF GROOM ~
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
wledge and belief that the information I provided is true an
o 0
o 0
o 0
o 0
pediment exists
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23. SUBSCRIBED AND SWORN TO BEFO
SIGNATURE OF TOWN OR CITY CLE ~
This license authorizes the marriage in New York State of
Relations Law ~11 to perform marriage ceremonies within New rk 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
{ } NAME(PRINT)~"
SEAL SIGNATURE ~ _c!f':''::'W''~, DATE 01JD412OO6
'-v-I M~W&l~ Rei. Wa~nger Falls. NY 12590
STREET CITYITOWN STATE ZIP
~~~R~~~RT~~~ 10~0~~~Ni:':~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0'sC RELIGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND /
PLACE INDICATED. 0 b 9 0 OTHER, SPECIFY
03
05 2006
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
DAY
YEAR
YEAR
TIME
MONTH
AM 1
:36 PM 0
05
2006
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY 'T'J..lZHr<;;}
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY F' ~4 ~.Il L
29. OFFICIANT
NAME (PRINT)
TITLE ~<'-; vK
~~TEi t. \ /0 G .
IVY { 2-S 21./
STATE -tIP
31. WITNESS TO
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/9B)
NAME (PRINT)
SIGNATURE ~