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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
. MARRIAGE
FROM THE GROOM
Denris E. Milhalm
COUNTY Dutchess
CITYfTOWN Wappinger
DISTRICT 1368
NUMBER
REGISTER 135
NUMBER
1. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 061.74-8190
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New Yark a. Dutchess
(ST Alii (COUNTY)
C. CHECK ONE Ll CITY 0 TOWN 0 VILLAGE
~~~CIFY BeaCon
D. STREET ADDRESS 20 Angela coun
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
11 /05
MONTH DAY
3. A. AGE 29
3B. DATE OF BIRTH
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4. EMPLOYMENT
A. USUAL OCCUPATION System Administrator
B. TYPE OF INDU~eY OR-'~u.sjtj!'~S_. IBM corp.
5. PLACE OF BIRTH MOUnE NSCO. NeW York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME 1l1omas Milhalm
B. COUNTRY OF BIRTH U 5 A
7. MOTHER
A. MAIDEN NAME Maureen Me Guire
B. COUNTRY OF BIRTH U S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVOffE CIVIL AN"tiLMENT
ZIP 12508
YES r1 NO
/ 1973
YEAR
DE"cf
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
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
o 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
e and belief that the information I provided is true 'l th~ I declare ~hat no legal impediment exists
22. SIGNAT4lRE OF BRIDE ~ k::. ~ -----
;' USE CURRENT NAME 09130I2OO3
DATE
This license authorizes the rriage in New York State of the bride and groom named above by any person authorized by New York Domesti(
Relations Law ~11 to performj11arriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
ijl' If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CllGJiLEfilK 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
CoIinn J. Powles
11. A. FULL NAME
MIDDLE
CURRENT SURNAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Milhalm
(OPTIONAL. SEE REVERSE) 110-72.8869
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. NewYark B. Orange
(STATE) ~ (COUNTY)
C. CHECK ONE 0 CITY IT TOWN 0 VILLAGE
~~CIFY CornWall
D. STREET ADDRESS 23 HerrlS Lane ZIP 12518
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
10 /13 A'98C
YEAR
13. A. AGE 22
13.B. DATE OF BIRTH
MONTH
OAY
14. EMPLOYMENT
A. USUAL OCCUPATION Admi~.twe Assistant
B. TYPE OF INDU~I~ B08t-n- R V warehouse
15. PLACE OF BIRTH . York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER ':
A. NAME Donald Powles
B. COUNTRY OF BIRTH U 5 A
17. MOTHER
A. MAIDEN NAME Constance DavIs
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV8RCE CIVIL AN'6'LMENT
DE'l)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
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
23.
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{ SEAL }
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TIME
MONTH
YEAF
SIGNATURE ~
MA2f.f
ATE 09130I2OO3
Falls, NY 12590
AM
12:46 PM
09
CI /TOWN
CCURRED
DAY 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.
26. SOLEMNIZATI
TIME
:3(> /0 A (}.J
. P ,.
,,""i~~':,'1j ~0'<th<ff. ~~ r
SIGNATURE~ ~~ ;tg~
MAILING ADDRESS .,-n . r-, .
F" C ~;.Ih..1:J' " wu II" ,/ ....-r-'V 1tIGrn;;/-
STREET f CITVfTOWN
30. WITNESS T CEREMONY
NAME (PRINT) \
SIGNATURE ~
DOH-9B (11/98)
ZIP
STATE
27. TYPE OF CEREMONY
o rrRELIGIOUS
9 0 OTHER, SPECIFY
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/Pv' C/1~,z"
STATE IP
TITLE
DATE
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTy?c/7h'
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF orVILLAGE OF
SPECIFY C" (01 S/'l'rJ[...)3
. . 'y
31. WITNESS TO CEREMONY
~
NAME (PRINT) ~5
SIGNATURE~ ,...::::J
~~