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STATE OF NI:W YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Glenn E. Knapp
MIDDLE CURRENT SURNAME
23. ~::~~=~oJNf~~~ cif?vB~~~~~E DATE
This license authorizes the marriage In New York S person authorized by New York
Relations Law ~11 to perform marriage ceremonies withi ew York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used onl
24. TOWN OR CITY CLERK
NAME (PRINT)
COUNTY_ Dutchess
CITYfTOlNN Wappinger
, DISTRICl 1 ') 68
~ NUMBER .:J
~5g~J~R 40
,. A. FUtl NAME
FIRST
..
N
a. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAl. SEE REVERSE) 095-58-6055
D. SOCIAL SECURITY NUMBER
2. RESIDENCEA.~~ York B. 2~~hess
C. CHiCK ONE 0 CITY D"TOWN 0 VILLAGE
~CIFY Wappinaer Poughkeepsie
STREET ADDRESS 2833 Route 9d Apt. 3 ZIP 12590
IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0"" NO
03 / 22 / 191
MONTH DAY YEAR
D.
E.
3. A. AGE 71
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Diesel Mechanic
B. TYPE OF INDUSTRY OR BUSINESS Package Pavem ent
5. PLACE OF BIRTH PounhJrp-ensie" New Y ork
(CITY, ~ IF NUT USA)
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME April Co~inf!
B. COUNTRY OF BIRTH l J ~ A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
n 0
Glenn Knapp
USA
DEATH
o
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) (CrrY, STATE/COUNTRY, IF NOT USA) SElF SPOUSE
o
o
o
w
U)
z
w
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{ SEAL }
'-v-I
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Suzanne M. Tandy
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
a. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Kna~~
(OPTIONAL - SEE REVERSE) 113-64-12 .
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE) 011 (COUNTY)
C. CHECK ONE 0 CITY 0 ,.OWN 0 VILLAGE
AND W .
SPECIFY applnger PoufW.keefsie
D. STREET ADDRESS 2833 Route ~d Ap . 3
1l~l:IU
....
YES 0 NO
/1915
YEAR
ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
05 /05
MONTH DAY
13. A. AGE 21
13.B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Retail Manager
B. TYPE OF INDUSTRY OR BUSINESS lens Grafters
15. PLACE OF BIRTH Beacon, New York
(CITY, BTATElCOUNTRY IF NOT USA)
16. FATHER
A. NAME Bernard Tandy
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Doreen Smith
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. 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 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) (CrrY, STATE/COUNTRY,IF NOT USA) SELF SPOUSE
o
o
o
25. B. SOlEMNIZATION'PERIOD
ENDS AT MIDNIGHT ON:
TIME
MONTH
YEAR
DAY
SIGNATURE ~
MAILING ADD~ESS
04/14/200
Falls NY 12590
04
15
20 3 06
AM
02:161
13 2003
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
27. TYPE OF CEREMONY
o ~ RELIGIOUS
10 OTHER, SPECIFY
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY Durl'+t~((
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY J.lC>P~61.L J UUi~D";
TITLE ~"'J ~t'
DAN'" ') ~t:I) '?
SATE
~R)
1:1
NAME (PRINT)
SIGNATURE ~
,
Affidavit for
Correction of Marriage Record
FOR OFFICIAL NYS USE ONLY
,
.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
STATE OF
} 55: tiP"'''
State File #
Groom:
Bride:
Date Completed:
COUNTY OF
We, r.l p-nn E. Knapp
(Groom)
being severally sworn, depose and say that:
and
Suzanne M. Tandy
(Bride/Maiden Name)
1. We reside at: 2811 Route 9D Apt. 3 Wappjn~ers Falls. New York 12'590
2. Marriage License issued by CityfTown: Town of Wappinjier
3. Date of Marriage
May 17. 2003
4. Error(s) appearing on record (list exactly):
a. Groom 2C Town of Wappinjier
b. Bride 12C Town of Wappinlier
c.
5. Correct information as it should appear (list exactly):
a. Groom 2C Tpwn of Pou~hkeepsie
b. Bride 12C Town of Pouihkeepsie
c.
6. Documentation Submitted:
a. Affidavit. License and Certificate of Marriage
b.
c.
This affidavit with supporting documentation is being made for the purpose of having the record of marriage show the
true facts and this affidavit will become a permanent record. The marriage record is filed with the State of New York.
Signature of Husband
Signature of Wife
Subscribed and sworn to
(affirmed) before me this
day of
Notary Public
NOTE: Certificate of Authenticity required for notary public outside New York State
(over)
..
.
.
e~ tJf St. Z'~
.'~'N^~ff"_~~"""""'~ L, .,',
- .
P.O. Box 10
Hopewell]unction, NY 12533
(845) 227-8382 · FAX (845) 227-3951
May 22, 2003
c;:pf'~
..-
Town of Wappingers
20 Middle Bush Rd.
Wappingers Falls N.Y. 12590
Attention Dot Groark
Town Clerk
Dear Madam:
This letter is to inform you that I, Reverend Philip T. Persico, a Roman Catholic Priest of the
Archdiocese of New York, residing at the Church of st. Denis, did witness the marriage of Glenn E.
Knapp to Suzanne M. Tandy on Saturday, May 1th 2003 at 2:30 PM at st. Denis Church in the Town
of East Fishkill.
This letter is to correct the mistake I made on the original wedding license where I listed the town as
Hopewell Junction instead of the correct area of East Fishkill.
z~
Rev. Phil' . Persico
Parochi lcar
St. Denis Church