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~ I A II:. UI- NI:.W YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
WilHam Howard Timmons
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITyrrOWN ViJappmqer
DISTRICT"; -.u;;:s:;
NUMBER "'VV
~5~~J~R 117
1 A. FUll NAME
FIRST
"-
N
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 11 r. f''''' 'I ':!'";t
D. SOCIAL SECURITY NUMBER \r \r I .......;
2 RESIDENCE A. N Y B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinger
o STREET ADDRESS 2 Bell AIr Lane ZIP 12590
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES "1'5 NO
07 /09 /1972
MONTH DAY YEAR
3. A AGE 32
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Insulator
B. TYPE OF INDUSTRY OR BUSINESS Local #91
5. PLACE OF BIRTH North Tarrytown. New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME James Edward TImmons
B. COUNTRY OF BIRTH U S A
7. MOTHER
A MAIDEN NAME CherYl Ann Di Ror.co
B. 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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
MONTH DA V YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED oa ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
a:
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21. SIGNATURE OF GROOM"
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()
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~ I "" I ~ rl~1:. ..u.Vloa::.n
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~
D;onn M \lV~<:;~p.H
FIRST MIDDLE CURRENT SURNAME
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT \lV~5'-<;;,\?l!
C, SURNAME AFTER MARRIAGE Timmnn<;;
(OPTIONAL - SEE REVERSE) . ~ r.
D. SOCIAL SECURITY NUMBER 1.i4. 70-> 1') ..,9
12 RESIDENCE A. N Y B_ f)lltch~<::.
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN D VILLAGE
AND \AI .
SPECIFY "vapDmaer
D. STREET ADDRESS 2 Bell Air Lane ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? DYES tl NO
13. A. AGE ~n 13.B. DATE OF BIRTH n9 L21:\ ~
MONTH TiA V YE~R
14. EMPLOYMENT
A. USUAL OCCUPATION Administrative Assistant
B. TYPE OF INDUSTRY OR BUSINESS Flavormatic Industries
15 PLACE OF BIRTH North Tarrvtown. New York
(CITY, STATE/COtmTRV IF NOT USA)
16. FATHER
A NAME Patrick Joseph "\tassel!
B. COUNTRY OF BIRTHU S A
11. A. FUll NAME
17. MOTHER
A. MAIDEN NAME .Joan norothy Morgan
B. COUNTRY OF BIRTHU S A
1 B. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
1
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) r"1 DEATH
C. DATE LAST MARRIAGE ENDED? 08 / 08 /2001
MONTH . J'A Y YEAR
D, ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES rJ 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
o 0
o 0
o 0
o 0
nd that I deCla~t ~ impediment exi S
USE CURRENT NAME
..
09/1512004
DATE
YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON'THE
DATE AND AT THE TIME AND
PLACE INDICATED.
STATE
27. TYPE OF CEREMONY
o ~L1GIOUS
9 0 OTHER, SPECIFY
10 CIVIL
A. STATE NEW YORK B. COUNTY VvJ5:J1"
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LAGE OF
SPECIFY ~~, 4I2U-/I:J: /VI4"vo/Z
NAME (PRINT)
SIGNATURE ~
DOH-9B (11/9B)
28. PLACE WHERE MARRIAGE OCCURRED
NAME (PRINT)
SIGNATURE ~