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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christopher M. Kearns
MIDDLE CURRENT SURNAME
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0 0
B. HOW DID LAST MARRIAGE END? (3) ~IVORCE (3) 0 ANNULMENT .J.21.g DEATH
C. DATE LAST MARRIAGE ENDED? 08 / 18 / 1~
MONT':iM' DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ITYES 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
1ST 06118/1998 PouahkeeDsI.. New York 0 r!I
2ND 0 0
3RD 0 0
4TH 0 0
ehef that the information I provided is true and that I declare that no legal impediment exists
TURE OF BRIDE ~ ~'t~J\J4k~ J1^~J
DATE 0BI23I2004
This license authorizes the .rriage in New York te of the bride and groom named above by any person authorized by Ne~ York Domestic
Relations Law ~11 to perform marriage ceremonies wit New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
r;J If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLE~K 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Glana .
{ ~ ~
SEAL SIGNATURE ~ 0BI23I2004
MA~",gpJi~S."::"__~ 11;43AM 08
'-v-I MlomeDLBf1 Rd, . NY 12590 PM
STREET STATE ZIP
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER. _v
SONS NAMED ABOVE ON THE ~ RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
29. OFFICIANT -J~ 1.-1 .JI.I
NAME (PRINT) Pf ~ TITLE
COUNTY Dutchess
CITYfTOWN Wappinger
DISTRICT .1~O
NUMBER ~
~5~~l~R 101
1. A. FULL NAME
FIRST
a.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 067.72-0886
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B. Dutchess
(STAITJ (COUNTY)
C. CHECK ONE ~ CITY 0 TOWN 0 VILLAGE
~~~CIFY Beacon
D. STREET ADDRESS 51 Dutchess Terrace ZIP 12508
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? r!! YES 0 NO
3. A. AGE 30 3B. DATE OF BIRTH 03 /22 / 1974
MONTH DAY YEAR
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
4. EMPLOYMENT
A. USUAL OCCUPATION Electrician
B. TYPE OF INDUSTRY OR BUSINESS Kearns Electrtc. Inc.
5. PLACE OF BIRTH Wapplngers Fells, New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Leo M. Kearns
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME GeorgIe Wheeler
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
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kristin A. Wiliams
-.J
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
11. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
YEAR
MONTH DAY
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
1ST
2ND
3RD
4TH
I, being duly sworn, depose and s ,
as to my right to enter into the m i
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Kearns
(OPTIONAL - SEE REVERSE) 086-46-5066
D. SDCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dulchess
(STAT~ (COUNTY)
C. CHECK ONE cr CITY 0 TOWN 0 VILLAGE
~~~CIFY Beacon
D. STREET ADDRESS 51 Dutchess Terrace ZIP 12508
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
11 /10 A966
MONTH DAY YEAR
13. A. AGE 'Sf
13.B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Athletic Trainer
B. TYPE OF INDUSTRY OR BUSINESS Heart Health
15. PLACE OF BIRTH Cold SprIng, New York:
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Charles Henry Williams, Jr.
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Merle AntoInette SerIno
B. COUNTRY OF BIRTH USA
1 B. NUMBER OF THIS MARRIAGE 2
DEATH
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21. SIGNATURE OF GROOM ~
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YEAR
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN..),tJrdj~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
)(6ITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY Pi) rJ all-6C t!~~.s, ~
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