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COUNTY Dutchess
CITYfTOWN Wappinger
1368
39
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseeh Edvvard Auger
MIDD E CURRENT SURNAME
:>> I A.I C riLe NUMDcn
(THIS SPACE FOR STATE USE ONL Y)
DISTRICT
NUMBER
REGISTER
NUMBER
L 0 SUPPLEMENTAL FILE
~
1. A FULL NAME
11. A. FUll NAME
FIRST
FROM THE BRIDE
Carrie Ann Meredith
MIDDLE CURRENT SURNAME
Meredith
FIRST
D-
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Auger
(OPTIONAL - SEE REVERSE) 131 ~ 7469
D. SOCIAL SECURITY NUMBER "'Q\r'
12. RESIDENCE A. NY B. Dutchess
(STATE) J (COUNTY)
C. CHECK ONE 0 CITY 0 '?OWN 0 VILLAGE
AND W .
SPECIFY aPPlnger
D. STREET ADDRESS 68 Marlorvllle Road ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 <0
11 / 07 /1976
MONTH DAY YEAR
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
NY
(STA;se) CITY O.roWN 0 VILLAGE (COUNTY)
Wapjlnger
D STREET ADDRESS 68 Marlorvllle Road
2. RESIDENCE A.
C. CHECK ONE
AND
SPECIFY
B.
ZIP 12590
o YES 0<0
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE
36
14. EMPLOYMENT
28
13.B. DATE OF BIRTH
3B. DATE OF BIRTH
13. A. AGE
4. EMPLOYMENT
A. USUAL OCCUPATION Manager
B. TYPE OF INDUSTRY OR BUSINESS Sam's Club
5. PLACE OF BIRTH South Kinaston. Rhode Island
(CITY, STATE/COU~ IF NOT USA)
6. FATHER
A. NAME Gerard John Auger, Jr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Chri~nA Ann CalpAntAr
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Spackenklll School
15. PLACE OF BIRTH Newburgh, New Yark
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME James Allen Meredith
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Barbara Spechar
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
DEATH
o
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
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9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) 0 ~ORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 1 Y 09 /
MONTH D~
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 J':IO
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
11JOQJ2001 Newport. Rhode Island 0 .; 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
ledge and belief that the information I provided is true and that I declare that no legal impediment exists
22. SIGNATURE OF BRIDE ~ C!\..~ 'i)'\Q~
. USE CURRENT NAME
OS/25f2005
(2) 0 DEATH
2001
YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
YEAR
MONTH DAY
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
(MONTH, DAY, YEAR) (CIlY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I, being duly sworn, depose a
as to my right to enter into the
21. SIGNATURE OF GRO
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23. SUBSCRIBED AND SWO N TO BE
SIGNATURE OF TOWN 0 CITY C RK~ DATE
This license authorizes 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
ri J.
TIME
MONTH
~
{ SEAL}
'-.-"
11:~
PM
05
IVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~
C. LOCATION OF CEREMONY
(CHECK ONE AND SF! Y)
o CITY OF OWN OF 0 VILLAGE OF
I W~/n.4~.
Z z
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~ ;S.... 29. OFFICIANT
.... z <t NAME (PRINT)
~ ~ (.)
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I- '"
~ ~ NAME (PRINT)
SIGNATURE ~
OOH-9B (11/98)