052
22. SIGNATURE OF BRIDE ~ ~
23. SUBSCRIBED AND SWORN TO BEFORE ME USE CURRENT NAME C'SIZ1I2CKJ5
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in tate of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies wit n New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
WOlf checked, this license I to be used only for the purpose of a second or subsequent ceremony.
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z ~ 24. TOWN OR ~'C.M8StenIan 25. A. SOLEMNIZATION PERIOD BEGINS
W { } ~ME(PRINT) ~
~. SEAL S E.. ~ . . . a'il.A.TEl&Zl/2f.XJ5
'-v-I i pplngeI" FIIIIB, NT 12590
STREET CITYITOWN STATE ZIP
~~~R~~~Ri':~ IO~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIM M DAY YEAR 0 0 RELIGIOUS 1 lWo"6IVIL
DATE AND AT THE TIME AND I J4"AM ~
PLACE INDICATED. i/- _ i J'3 <-';;) 9 0 OTHER, SPECIFY
29. OFFICIANT """""15J1J7) L s~/../;
NAME (PRINT) J,J. .,,~ ~ IIV~ TITLE
SIGNATURE ~ _ _ ~ .,{ L &_ DATE
MAll~ Ag)SS ~ A
STREE~ klh~ C~~~. , #t~ t- :;r
30. WITNESS TO CEREMONY
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
Wa~~IjQ~OOM
Dlttclu 55
COUNTY Wappinger
CITYrro:'1388
DISTRICT
~~~I~~~R 52
NUMBER
1. A. FULL NAME
MIDDLE
CURRENT SURNAME
FIRST
11.
N
8. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE .1~ ""'" ~
(OPTIONAL. SEE REVERSEjo;l , -, ~-~
D. SOCIALSE~ DutclIess
2. RESIDENCEA. (STATE)'; B. (COUNTY)
C. CHECK ONb-....lil.~;.zOWN 0 VILLAGE
AND r-UUWlII\VVtIDI~
SPECIFY SS1 8heefe Roed Lot 22
D. STREET ADDRESS ZIP
E. IS RE:ifCE WITHIN LIMITS OF CITY OR INCORPORATE~GE? ~D
3. A. AGE 3B. DATE OF BIRTH ~
MONTH DAY
4. EMPLOYMENT RaaIing Supervisar
A. USUAL OCCUPATION C B 8 eorporatIon
B. TYPE OF IND~Sfr.d8..
5. PLACE OF BIRTH
(CITY, STATEICOUNTRY IF NOT USA)
6. FATHER Forrest W. Alcorn
A. ~AME USA
B. COUNTRY OF BIRTH
12580
.;
Y~
YEAR
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7. MOTHER AnIta J. Shepherd
A. MAIDEN NAME USA
B. COUNTRY OF BIRTH 2
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DlVerCE CIVIL A~ULMENT
D,TH
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B. HOW DID LAST MARRIAGE END? (3) 0 DIV0a7 (3) CO!NULME~ 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
o
o
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NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. FULL NAME l1leresa Marie Me Keon
FIRST MiiU
8. BIRTH NAME (MAIDEN NAME), ~IFFERENT 1TeIS...
C. SURNAME AFTER MARRIAGE corn
(OPTIONAL - SEE REVERSEu56-(~(4
D. SOCIALS~NUfjlI!E.!l.=
12. RESIDENCE A. TGfK B. outcheIs
~) (COUNTY)
C. CHECK TOWN 0 VILLAGE
AND e
SPECIFY 8If1 SI_1'b Road I.d 22
D. STREET ADDRESS
CURRENT SURNAME
12590
ZIP .,
o iiW9 NO
YEAR
E. IS RE!iiNCE WITHIN LIMITS OF CITY OR INCORPORA~VILLAGE~
13. A. AGE 13.B. DATE OF BIRTH
MONTH DAY
14. EMPLOYMENT
. A. USUAL OCCUPATION Self Emplayed
B. TYPE OF IND'eiI(f..1iItS=~nu ServIce
15. PLACE OF BIRTH . DI'k
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER Thomas C Burress
A. NAME .
B. COUNTRY OF BIRTHU SA
17. MOTHER
A. MAIDEN NAME Diane G. Warren
B. COUNTRY OF B;JJ 6 ~
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A~ULMENT
.;
:: :~~:I:~;TM~:~:~~E~~~~~~;3L~L~Vti.. , ~NNULM/19fif DEATH
MONllll" DAY YEAR
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
~"'''rrpcj'ntCWOiit~n. SELF SPO~E
1ST 0 0
2ND 0 0
3RD 0 0
o 0
that I declare that no legal impediment exists
"
DttTH
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY )P'iZll'ff
~ -:::TUsrx.e
'l/I3/or
, ).~J8
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF IM'"fbWN OF 0 VILLAGE OF
SPECIFY -,::b o6HKlC PI' E
NAME (PRINT)
SIGNATURE ~
31. WITNESS TO