134
lL
N
I-
Z
ill
(J)
ill
tD
g
=>
o
I
(J)
Z
o
>=
<<
c:
I-
(J)
G
w
c:
w
<:J
<<
a:
c:
<<
::;
lL
o
ill
I-
<<
o
u:
>=
c:
w
o
w
c:
W
I
;::
(J)
(J)
W
c:
o
o
<<
>-
lL
o
W
lL
(J)
~ I A I t: UI- Nt:W YUHK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM .
Matthew Paul Daves
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
. 0 If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CI~ J. Manse 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
Dutchess
COUNTY ~~
CITYfTOW!:lI368 nger
DISTRICT 1
~~~I~~R 134
NUMBER
1. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) ~9-1656
D. SOCIAL SECl~TVUMBER
2 RESIDENCE A. B. DutCheSS
(STATE)" (COUNTY)
C ~n6CK ON~ppfi8P TOWN 0 VILLAGE
SPECIFY 22 A C~ Ridge Drive
D. STREET ADDRESS ZIP
E IS RES~CE WITHiN LIMITS OF CITY OR INCORPORATED $GE? 1Z
3. A. AGE 38. DATE OF BIRTH /
MONTH DAY
12S90
.;
Y/q~8
YEAR
4. EMPLOYMENT
Selvlce Technidan
A. USUAL OCCUPATION Almw
8. TYPE OF INDU1ij~eou"" Tex.
5. PLACE OF BIRTH ~W ".7.
(CITY. STATEiCOUNTRY IF NOT USA)
6. FATHER
A. NAME
Charles Richard Daves
USA
B. COUNTRY OF BIRTH
7. MOTHER
A MAIDEN NAME
Brenda Mae Brown
USA
1
B. COUNTRY OF BIRTH
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO(fE CIVIL ANro'LMENT
DE1)H
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
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
1D. 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
c:
w
'"
'"
~
z
o
z
<<
I-
W
W
a:
I-
(J)
o
o
o
w
fJ)
Z
W
()
:J
~
{ SEAL }
~
z Z
~ ~ w
~ ;S I- 29. OFFICIANT
I- Z <C NAME (PRINT)
g,; a\ ()
~ g u::
~ u- i=
~ 0 a:
~ ~ w
w 0 ()
I- "'
o
z ~
SiGNATURE ~
DOH-98 (11198)
~ I "" I ~ rn..~ I'IVI'I..,L.n
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Jennifer Lee Schneider
~
11. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B BIRTH NAME (MAIDEN NAME), IF ~ENT
C. SURNAME AFTER MARRIAGE es
(OPTIONAL - SEE REVERSE) ~- (01 0
D. SOCIAL SEC~lo/UMBER
12. RESIDENCE A. B. DutcheBB
(STATE I ., (COUNTY)
C. CHECK O"h..L--.JJ CITY 0 TOWN 0 VILLAGE
AND VVIIpplInger
SPECIFY 22 A Chelsea Rldyv OI1ve
D. STREET ADDRESS ZIP
E. IS RES~CE WITHIN LIMITS OF CITY OR INCORPORATED~LAGE? 0
13. A. AGE 13.8. DATE OF BIRTH /'Zl
MONTH DAY
14. EMPLOYMENT C
A. USUAL OCCUPATION LlstonlEu.~:rvice Rep.
8. TYPE OF INDUI'iOiiB~yOl'k
15. PLACE OF BIRTH I
(CITY. STATE/COUNTRY IF NOT USA)
16 FATHER William C. Schneider
A. NAME USA
B. COUNTRY OF BIRTH
12590
.,
Y)97~O
YEAR
17. MOTHER Norma I. Portela
A. MAIDEN NAME USA
8. COUNTRY OF BIRTH 1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DI'tjRCE CIVIL AN~LMENT
DEt)H
8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
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
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
o
o
o
1ST
2ND
3RD
o 0
o 0
o 0
o 0
pediment exists
y ~
101D812004
DATE
by New York Domestic
YEAR
ZIP
1~IVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~
C. LOCATION OF CEREMONY
(CHECK ONE ANy!3PECIFY)
o CiTY OF w'TOWN OF 0 VILLAGE OF
SPECIFY