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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christooher George Crumbie
MIDDLE CURRENT SURNAME
COUNTY DutchesS
CITYfTOWN Wagpnaer
DISTRICT 1368
NUMBER
~~~~J~R 19
A. FULL NAME
FIRST
B BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTlONAL- SEE REVERSE) 1''lft-'78-8691
D_ SDCIAL SECURITY NUMBER ~
2. RESIDENCE A_ NY B. DutcheBB
(STATE) ..J (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN LJ'" VILLAGE
~~~CIFY Wappingers Falls
D STREET ADDRESS 17 North GIlmore Blvd. ZIP 12590
E_ IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? c1"YES 0 NO
08 / Q2 / 1971
MONTH DAY YEAR
3 A_ AGE 33
38. DATE OF BIRTH
4_ EMPLOYMENT
A_ USUAL OCCUPATION Ublity VVarker
8. TYPE OF INDUSTRY OR BUSINESS Ararnark CorD-
5_ PLACE OF BIRTH Klnaston. JemIlc8
(CITY, STATE/COUNTRY IF NOT USA)
6_ FATHER
A_ NAME Lascelles Crumbie
8. COUNTRY OF BIRTH J8m81c8
7_ MOTHER
A MAIDEN NAME lucille Me Cella
8._ COUNTRY OF BIRTH J8m81c8
B. NUMBER OF THIS MARRIAGE 1
9_ PREVIOUS MARRIAGES
A_ NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
Coo 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
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
NoT
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L 0 SUPPLEMENTAL FILE
~
FROM THE BRIDE
Madge Marie Ffrench
FIRST MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Ffrench
C SURNAME AFTER MARRIAGE Ffrench- Crumbie
(OPTIONAL - SEE REVERSE) 1ft.. Oft ""A'7
D. SOCIAL SECURITY NUMBER ~
12 RESIDENCE A NY B. Dutchess
Coo CHECK ONE (STA~) CITY 0 TOWN ~llLAGE (COUNTY)
AND \A"--'i Falls
SPECIFY YW8Mo'lngel'S
D. STREET ADDRESS 17 North Glmore Blvd. ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? Lf YES 0 NO
12 /29 /'1964
MONTH DAY YEAR
11 A. FULL NAME
CURRENT SURNAME
13. A_ AGE 40
13.6. DATE OF BIRTH
14. EMPLOYMENT
n--Io~ A .ate
A_ USUAL OCCUPATION r-IUUIAoUVII.188oa
B. TYPE OF INDUSTRY OR BUSINESS Coca Cole Co.
15. PLACE OF BIRTH Kingston, J8m8Ic8
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A_ NAME Albert Ffrench
B. COUNTRY OF BIRTH J8m8Ic8
17. MOTHER
A. MAIDEN NAME ERie Unton
B. COUNTRY OF BIRTH J8m81c8
1 B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A_ NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE lMF 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) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1 ST 0 0 1 ST
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I, being duly sworn. depose and say. that to the best of my knowledge and belief that the information I provided is true a
as to my right to enter into the m~s\1te- \ \ C I'
21 SIGNATUREOFGROOM~ '---- \,\'''~ ~ ,~,,-(\\\"\"':,.\
E C RENT NAME
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23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license au~"!eirthe marriage in New York State of the bride and groom named above by any person authorized
Relations l.aw ~11 to perform marriage ceremonies within New York State, THIS LICENSE VALID IN NEW YORK STATE ONL Y-
O'1f checked. this license is to be used only for the purpose of a second or subsequent ceremony_
_~ 24_ TOWN OR CI CLER.K 25_ A_ SOLEMNIZATION PERIOD BEGINS
{_ '_:}. NAME (PRINT.) . Glona J. Morse TIME MONTH
SE~~ ' SIGNARJRE, ~ DATE 0311
'-v-iI '. MAt~ .:iBebush Rd, Wappinger Falls. NY 12590 10:4S\M 03
_ '". ~ ET CITYfTOWN STATE ZIP PM
I CERTIFY tHAT I SOlEMNIZED 26_ SOLEMNIZATION OCCURRED ' 27. TYPE OF CEREMONY
THE MARRIAGE OF THE I'f;R--,.
SONS NAMED ABOVE qN fltE TIME M DAY YEAR 0 0 RELIGIOUS
DATE AND AT THE TIME AND AM
PLACE INDICATED_ M 9 0 OTHER, SPECIFY
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29_ OFFICIANT
NAME (PRINT)
TITLE
DATE
SIGNATURE ~
MAILING ADDRESS
DATE 0311812005
by New York Domestic
YEAR
28_ PLACE WHERE MARRIAGE OCCURRED
10 CIVil
A. STATE NEW YORK B. COUNTY
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY
STATE ZIP
31_ WITNESS TO CEREMONY
NAME (PRINT) NAME (PRINT)
SIGNATURE ~
OOH-9B (11/98)
SIGNATURE ~