019 .. N I- Z W '" W lD o ...J ::l o :l: '" Z o ~ <( CC I- '" C3 W cc W , Cl <( a: CC <( ::; L1. o W I- <( tl u: ~ CC W tl W CC W :l: ~ '" '" W CC o o <( >- L1. U W .. '" ~:i:z ::l!::Q W ~~~ I- t;~~ <( ::ltlW 0 ~~g u: z- n~~ t= !to", Wa: 01->- W~<3 0 b~'" Z:J~ :; I A II: UI- NI:W YURK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM 1ST 2ND 3RD 4TH I, being duly sworn, depose and say, t as 10 my righllo enter inlo the marri e s ,...--.: 21. SIGNATURE OF GROOM ~ ." -- 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. D If checked. this license is to be used only for the purpose of a second or subsequent ceremony. { ~ } ::~~::}~CITY CLER~ . ~t.....:- 25. A~I:~LEMNI::~TNHPERIOD BEG~:AR SEAL SIGNATURE ~ . DATE O':t11912DO MAILING ADDRESS . '-..,-I STR~ Middlebu&h Rd, \~~ Falls, ~TE 12590 ZIP 03 20 2 ~~~R~:Ri~~~ 10~0~~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 D RELIGIOUS 1 ~ CIVIL DATE AND AT THE TIME AND , ,'..... . PLACE INDICATED. .c;...., PM O~ 9 D OTHER, SPECIFY COUNTY 0tItchess CITYfTOWN Wappinger ~~J~~c~ 1368 ~G~~J~R 19 1. A. FULL NAME MID~ur PlatlRRENT SURNAME FIRST B. BIRTH NAME, IF DIFFERENT C. SURNAME AFTER MARRIAGE (OPTIONAL. SEE REVERSE) D. SOCIAL SECURITY NUMBER 067-34 7949 2. RESIDENCE A. . ~~TE) B. ~8&S C. X~~CK ONE D CITY cvrOWN D VILLAGE SPECIFY Wappinger o STREET ADDRESS 12 Bowdoin lane ZIP 12590 E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES IYNO Mom/~/y~ 3. A. AGE 61 4. EMPLOYMENT 3B. DATE OF BIRTH A. USUAL OCCUPATION Looksmith B. TYPE OF INDUSTRY OR BUSINESS OWR Business 5. PLACE OF BIRTH ~m~y~M~ork 6. FATHER A. NAME Meyer Platt 8. COUNTRY OF BIRTH USA 7. MOTHER A. MAIDEN NAME Ullian Binsbufg 8. COUNTRY OF BIRTH USA 8. NUMBER OF THIS MARRIAGE :2 9. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT DEATH 1 0 0 B. HOW DID LAST MARRIAGE END? (3) ~IVORCE (3) D ANNULMENT (2) D DEATH C. DATE LAST MARRIAGE ENDED? Oa/"1 / """'" MONTH DA'I'" ~ D. ARE ANY FORMER SPOUSE(S) ALIVE? D~S D NO 10. IF PREVIOUSLY DIVORCED OR ANNULlED, PROVIDE THE FOLLOWING INFORMA nON DATE OF DECREE PLACE ISSUED AGAINST WHOM (MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE 0812112002 PGyghkeepsie, New Yark: D D D W UJ Z W o :::J 29. OFFICIANT NAME (PRINT) SIGNATURE ~ MAILING ADDRESS Mn?fJ(cff)l.J (/1 \. ) STREET CITYfTOWN 30 WITNESS TO CEREMONY NAME (PRINT) P,f;..,i s<!..; / I ~ SIGNATURE~ ~~ DOH.9S (11I9B) ~~ o:>>.I-\IC. rll..c. ,..umac.n (THIS SPACE FOR STATE USE ONLY) "~ L 0 SUPPLEMENTAL FILE FROM THE BRIDE aa~ Jean MtCQlrtl'uRNAME 11. A. FULL NAME FIRST B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Larrabee C. SURNAME AFTER MARRIAGE (OPTIONAL. SEE REVERSE) D. SOCIAL SECURITY NUMBER D7fi.-4B--S194 12. RESIDENCE A. N v B. n......h...."s l(mTE) "'~ C. CHECK ONE D CITY D.;OWN D VILLAGE AND \AI. . SPECIFy.\<.Vapplnger D. STREET ADDRESS 12 Bc1Mdoin Lane 13. A. AGE 46 14. EMPLOYMENT ZIP 12590 YES eVNO /1~ E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? D ca1/ M QI 13.B. DATE OF BIRTH A. USUAL OCCUPATION L.ock&mith B. TYPE OF INDUSTRY OR BUSINESS Platt's CouRtly Village 15.PLACEOFBIRTH ~~~fj)~ 16. FATHER A. NAME C'iUleton F, Larrabee B. COUNTRY OF BIRTH U S ,4, 17. MOTHER A. MAIDEN NAME PFiseilla M. TOFfElnee B. COUNTRY OF BIRTH USA 18. NUMBER OF THIS MARRIAGE :2 19. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT DEATH o 0 1 8. HOW DID LAST MARRIAGE END? (3) D DIVORCE (3) D ANNULMENT (2) D ~ATH C. DATE LAST MARRIAGE ENDED? 03/ n1 / ..0A3 MONTH DAY YrP D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES [NItO 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 2ND 3RD D D D D D D DATE 03l19J2004 by New York Domestic MONTH YEAR 05 18 2004 2B. PLACE WHERE MARRIAGE OCCURRED A. STATE NEW YORK B. COUNTyf~,.q..vl C. LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) D CITY OF Jlf TOWN OF D VILLAGE OF SPECIF~i(l- tlsn, I.(., ..v NAME (PRINT) SIGNATURE ~