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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
{,..hridnr'ltvoor PSIIII RRtchie
MIDDL~ CURRENT SURNAME
23. SUBSCRIBED AND SWORN BEFORE M
SIGNATURE OF TOWN OR ITY CLERK ~ DATE
This license authorizes the marriage in New York S authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies withi New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o II checked, this license is to be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
::!
COUNTY Dutchess
CITYITOWN Wappinger
~1j'~~~T 1388
~5~~J~R 144
1. A FULL NAME
FIRST
"-
N
B BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER 080-62-4138
2 RESIDENCE A. G9A'i\?ectiCut B. fcmmeld
C CHECK ONE 0 CITY D,I'l'OWN 0 VILLAGE
AND
SPECIFY RrnnkfiP.ld
D. STREET ADDRESS 22 I=lI:~'It Ctlurt
ZIP MA04
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES eJ'NO
MONQ1 / >>p / y~J~7
3. A. AGE 32
38. DATE OF BIRTH
4. EMPLOYMENT
A USUAL OCCUPATION {,JiRnt RRrvi~ ec,f18ultant
8. TYPE OF INDUSTRY OR BUSINESS Cendant Mobility
5. PLACE OF BIRTH (e-9~~~ York
6. FATHER
A NAME PSlIII .JlRfIo.ph RBtchie
8. COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Chrlstlnl Mlrle DI Marco
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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
o
(2) 0 DEATH
(3) 0 ANNULMENT
/ /
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. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
J, being duly sworn, depose and say,
as to my right to enter into the marri
21.
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{ SEAL }
'-v-I
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICA TED.
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~. J strilSB.fENT SURNAME
11. A FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Satchie
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 132-6s..8053
12. RESIDENCE A. "WfwE;w'ork . B. Q~esg
c. CHECK ONE 0 CITY D,,:JWN 0 VILLAGE
AND St 'II
SPECIFY OIlllVl e
D. STREET ADDRESS 3 ,Jodi Court ZIP
12582
YES ~O
/1~7~
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
MO~/W
13. A. AGE 28
14. EMPLOYMENT
13.B. DATE OF BIRTH
A. USUAL OCCUPATION Medical Secretary
B. TYPE OF INDUSTRY OR BUSINESS Danbury Orthopedics
15. PLACE OF BIRTH (~~~ ;t~
16. FATHER
A. NAME Thomas J, str.-ser
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Nora O. Mo Klnnon
8. COUNTRY OF BIRTH Canada
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o 0
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
o
(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 1ST 0 0
o 2ND 0 0
o 3RD 0 0
o UH 0 0
eliel that the information J provided is true and that I declare that no legal impediment exists
22. SIGNATURE OF BRIDE ~41112-( 1~ ~ C./.1. _~
USE CURRENT NAME
TIME
MONTH
YEAR
MONTH
YEAR
10
09
12
07 2003
ATE
27. TYPE OF CEREMONY
o ~RELlGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
A. STATE NEW YORK B. COUNTY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF II' TOWN OF 0 VILLAGE OF
SPECIFY WaJ'lJO"AI~r'r
, I V
28. PLACE WHERE MARRIAGE OCCURRED
29. OFFICIANT
NAME (PRINT) e V.
SIGNATURE ~ 12~
MAI~I~G/DD'3IiSS .
'1CL m a ,If) Sf.
STREET
30. WITNESS TO
P IJ (T"I?
DATE It? /~ '1/03
v' .
cY O'trJ/
STATE
NAME (PRINT)
31.
NAME (PRINT)
SIGNATURE ~