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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
B~~~~ J MIJrr~~RENTSURNAME
o 0 1ST 0 0
o 0 2ND 0 0
o 0 ~D 0 0
o 0 4TH 0 0
knowledge and b lief that the information I provided is true and that I declare that no legal impediment exists
22. SIGNATURE OF BRIDE ~ -II. / /i{~ /1/. (JL ~
/ J I '\ -I-tf" USE~NT NAME
~ / ~ ~ DATE 10103/2002
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law 911 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o \I checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CL.ERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) GlOria
{TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ DATE 10/03/2002
MI\~Na.ADmlESS 0:02 AM 10
~ ~u IVllUuteU sh Rd, ppl ger Falls, NY 12590 PM 04 2002 12 02 2002
STREET CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZA ION OCCURRED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR o.J:l...RELlGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER. SPECIFY
COUNTY Dutchess
CITYfTOWN Wappinaer
~~~~~c~ 1368
~5~~J~R 162
1. A FULL NAME
FIRST
B BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)113 50 3 8
D. SOCIAL SECURITY NUMBER - - 6 9
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY tJ TOWN 0 VILLAGE
~~~CIFY La Granaeville
o STREET ADDRESS 4 Depot Lane ZIP 12540
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES"6 NO
OR /~~ / ~~7~
MONTH DAY YEAR
3. A. AGE 31
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Carpenter
B. TYPE OF INDUSTRY OR BUSINESS Self-emploved
5 PLACE OF BIRTH Glens Falls, Newfoundland. Canada
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME Joseph Murphv
8. COUNTRY. OF BIRTH USA
7. MOTHER
A MAIDEN NAME Dorothy Scheid
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
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
II:
W
10
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21. SIGNATURE OF GROOM ~
23.
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29. OFFICIANT
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/98)
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
qp1ct /~ ./~ ..tI~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
I::l 'd' ~a Ch' f
)}IOJU,' I I r1$ I~RRENT SURNAME
11. A. FULL NAME
FIRST
DEATH
o
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. S~~~~JN~~~~:~~e~~s~llrphY
o SOCIAL SECURITY NUM8ER 064-70- ?611
12 RESIDENCE A. Np.~AXrrk B D\!Mo~SS
C. CHECK ONE 0 CITY ISi!I' TOWN 0 VILLAGE
~~~CIFY I a GrangAvilh:.
D. STREET ADDREss4 Depot I ane ZIP 1 ?t)40
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
13. A. AGE3~ 13.B. DATE OF BIRTH JJJrH /2~y ""~7A~
14. EMPLOYMENT
A. USUAL OCCUPATION T eanhpr
B. TYPE OF INDUSTRY OR BUSINESS poughkeepsie City Schl
15. PLACE OF BIRTH Pouahkeeosieo' New Y nrk
(CITY:"!iTATE/COUNTRY I. NOT USA)
16. FATHER
A. NAMEJohn Christie
B. COUNTRY OF BIRT..u S A
17. MOTHER
A. MAIDEN NAME l-!p!pn F=lynn
B. COUNTRY OF BIRTJJ S A
18. NUMBER OF THIS MARRIAGE 1
19. 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?
(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
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY Y '" .
TITLE
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0'lOWN OF 0 VILLAGE OF
SPECIFY ;:... r~.c"".rcl'S c-,
DATE
STATE ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) .(