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STATE FILE NUMBER
(THIS SPACE FOR S7 ATE USE ONL Y)
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COUNTY Dutchess
CITYfTOWN Wappinger
~~J~~~T 1368
~G~~J~R 118
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
1. A FULL NAME James Robert Phelan
FIRST MIDDLE CURRENT SURNAME
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B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSEhi 27 7 7
D. SOCIAL SECURITY NUMBER I - 4-4 01
2 RESIDENCE A. New York 8. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY WappinQer
D. STREET ADDRESS 11 Boxwood Close ZIP 12533
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES"tJ NO
3. A AGE25 38. DATE OF BIRTH 01 /18 /j QRO
MONTH DAY ~
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4. EMPLOYMENT
A USUAL OCCUPATION Teacher
8. TYPE OF INDUSTRY OR BUSINESS
5. PLACE OF BIRTHBronx. New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME James Michael Phelan
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Ann Car:yl Stecher
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. 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
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
L 0 SUPPLEMENTAL FILE
.J
FROM THE BRIDE
11. A. FULL NAME laur61 Flizabeth Vincenzi
FIRST MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. S~~~~\~M\~~~~t:e~~sWncenzi Phelan
D. SOCIAL SECURITY NUMBER 133-6S-S177
12 RESIDENCE ANeJ.A~"rk 8. DLf!~~s
C. CHECK ONE 0 CITY @! TOWN 0 VillAGE
AND' .
SPECIFyWapplngp.r
D. STREET ADDREss11 Boxwood Close zIP17~:!.:!.
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES o,(J NO
13. A. AGJ=27 13.B. DATE OF BIRTH "? ../.. "../-7
-t i!li6NTH IJti DAY" 9-fTEAR
14. EMPLOYMENT
A USUAL OCCUPATIONI RWYPJr
8. TYPE OF INDUSTRY OR BUSINESSCIJ8rtRrRro & OJJ8rtRraro
15. PLACE OF BIRTtBronx New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A NAMEVictor Anthony Vinr.PJn"i
B. COUNTRY OF BIRTU S A
17. MOTHER
A. MAIDEN NAME Dorothy Ann Brook~
8. COUNTRY OF BtRTU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
o 0
DEATH
n
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNUlED, PROVIDE THE FOLLOWING IIIIFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, that to the best of
as to my right to enter into the marriage stat
21. SIGNATURE OF GROOM ~
23. ~~J~~~~Do~NT~~~O~~ ~~g~:~ DATE 09/?1I7nn~
This license authorizes the mar ge in New York State f 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
{ } NAME (PRINT)~ Jh TIME YEAR
SEAL SIGNATURE ~ - . ....' ".. - . ...-...-. DATe09/21 12005
~ ~b'~ale ush Rd, Wappinger Falls. NY 12590 AM
STREET CITYfTOWN STATE ZIP 5:52 PM
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27ZTYP F CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 RELIGIOUS 1 0 CIVil
DATE AND AT THE TIME AND ,3.00 AM
PLACE INDICATED. - 9 0 OTHER, SPECIFY
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NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
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YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTyOutf ~~SS
dlctlAlJ,-,~1 Ie. 13 ~5 to
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C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WN OF 0 VilLAGE OF
SPECIFY fu~..} hSH~"\,..L-
31.
NAME (PRINT)
SIGNATURE ~