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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Gregorv Kimba Dorsett
MIDDLE CURRENT SURNAME
COUNTY DutchesS
CITYITdWN WaPPinger
~~J~~cFi 1368
~5~I~J~R 7
1. A. FULL NAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 092 CD 0304
D. SOCIAL SECURITY NUMBER -ou-
2 RESIDENCE A. New York B. New York
(ST A Ti) (COUNTY)
C. CHECK ONE ~ CITY 0 TOWN 0 VILLAGE
~~~CIFY New York City
D. STREErADDRESS 1884 Third Avenue Aft. 5 Azjp 10029
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? r'!1 YES 0 NO
3. A. AGE 20 3B. DATE OF BIRTH M~ / ~1v / l~
4. EMPLOYMENT
A. USUAL OCCUPATION Carpenter's Assistant
B. TYPE OF INDUSTRY OR BUSINESS Kitchen Remodeling
5. PLACE OF BIRTH Manhattan New V ork
(CITY, STATElCOUN'rRY IF NOT USA)
6. FATHER
A. NAME Greg.ory G Dorsett
8. COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Elizabeth Flgl.eroe
8. COUNTRY OF BIRTH USA
8. 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
(3) 0 ANNULMENT
/ /
(2) 0 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. STATElCOUNTRY. IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Amanda Hedwig Catherine Abrll77'o
FIRST MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Dorsett
(OPTIONAL - SEE REVERSE) 07r:.: 7D.7602
D. SOCIAL SECURITY NUMBER 'I i"'L~_
12. RESIDENCE A. New Vork B. Dutchess
(ST A Tt) (COUNTY)
C. CHECK ONE 0 CITY [!"TOWN 0 ViLLAGE
~~~CIFY East Fishkill
D. STREET ADDRESS 2 Treeline Drive ZIP 12590
E. is RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
13. A. AGE 19 13.8. DATE OF BIRTH M~~H /1a\v /f"9~~
14. EMPLOYMENT
A. USUAL OCCUPATION Un - EmplQyed
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Wannlnael'!>> Fall~, Ni!lW York
(CITY~TEi!5UNTRY IF NOT USA)
16. FATHER
A. NAME Edward Am 177'0
8. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Ke~~n Cornell
B. COUNTRY OF BIRTH IJ ~ A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o Q
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
MONTH 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
(MONTH. DAY. YEAR) (CiTY. STATElCOUNTRY. IF NOT USA) SELF SPOUSE
o
o
o
. SIGNATURE OF BRIDE ~
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1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
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I, being duly swom, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declar
as to my right to enter into the marr' estate. .
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York St e of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies withi New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is 0 be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
21. SIGNATURE OF GROOM ~
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{ SEAL }
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NAME (PRINT)
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29. OFFICIANT
NAME (PRINT)
by New York Domestic
TIME
MONTH
YEAR
MONTH
YEAR
ZIP
AM
02:49 PM 02
08
04
08 2005
~IVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNT~L*kte.
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY~1 k~(?r
d-~
ZIP
31. WITNESS TOB.REMONY
NAME (PRINT) f-a r 1-11& 'ct 6- ?YceL.. VI. eJ
IE? /1- 7i3?'(A ~ }
SIGNATURE ~