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, Dutchess
COUNTY Wappinger
CITYfTOWN
DISTRICT , 3S8
~~~I~~~R 16
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Damon Michael Munz
~
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Georganna Bowden
1. A. FUU NAME
11. A. FULL NAME
ARST
MIDDLE
CURRENT SURNAME
FIRST
MIDDLE
CURRENT SURNAME
0-
N
B. BIRlH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTiONAl - SEE REVERSE) 042-56-2933
D. SOCIAL SECU~ NUMBER
2. RESIDENCE A onnecticut B. Middlesex
(STATE) 4 (CDUNTY)
C. CHECK ONE K"II- 0 CITY TOWN 0 VILLAGE
~~CIFY 1 Ingwo
D. STREET ADDRESS 138 River Road
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Munz
(OPTIONAL - SEE REVERSE) 11 B-7Q..2471
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. Connecticut B Middlesex
(STATE) ~ (COUNTY)
C. CHECK ONEi..'II' 0 CITY TOWN 0 VILLAGE
~~~CIFY KI InQ'tN
D. STREET ADDRESS 1 ~ ~lVer Roaa
06419
06418
ZIP
YES r! NO
/l9n
ZIP
YES r!! NO
/ 1976
YEAR
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
3. A. AGE 28 3B_ DATE OF BIRTH 09 / 11
MONTH DAY
4. EMPLOYMENT
A. USUAL OCCUPATION store Manager
B. TYPE OF INDUS~Y OR 1IIJSINESS Clafk1s Company
5. PLACE OF BIRTH New Naven, connedlCUl
(CITY, STATEICOUNTRY IF NOT USA)
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
07 /19
DAY
13. A. AGE 27
13.B. DATE OF BIRTH
MONTH
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Sloomfiela Public sen.
15. PLACE OF BIRTH Newburgn, New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Terence stock Bowden
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Rosemary Spina
B. COUNTRY OF BIRTH USA
1 B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV&RCE CIVIL ANNOLMENT
6. FATHER
A. NAME Louis Anthony Munz, Jr,
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Ursula Jane Babbitt
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO'lfE CIVIL ANN~LMENT
DEAl)
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(210 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
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 FOUOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONITH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I, being duly sworn, depose and sa ,that to the best of m
as to my right to enter into the m . estate.
21. SIGNATURE OF GROOM ~
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
knowledge and belief that the information I provided is true a
o
o
o
2. SIGNATURE OF BRIDE ~
w
en
z
w
o
::::i
23. ~~~~~~Do~i'~~: ri:ivB~~::~E DATE 03I06f2005
This license authorizes the marriage in New York St authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within ew 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 CLEI;!K 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Gloo J.
{. TIME MONTH
= ~~ifa~ Rd, AM 03
STREET ZIP 01:49PM
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
YEAR
10 CIVIL
26. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY {/,Ll"u-4/ ~
C. LOCATION OF CEREMONY tf
(CHECK ONE AND SPECIFY)
Iif6ITY OF 0 TOWN OF 0 VILLAGE OF
/1/;'"1"-0 ~ j
CJ
()
ZIP
31. WITNESS TO CEREMONY
'''''''''""~~_~tie Lavn~
"SIGNATURE~' V ~
SPECIFY