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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Dave F. Harris
MIDDLE CURRENT SURNAME
19> PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 01 / 20 / 1993
MONT~ 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 0 1ST 01/20/1993 White Plains, New York 0 ~
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
owledge and belief that the information I provided is true and that I declare that no legal impediment exists
- 22. SIGNATURE OF BRIDE. ~~~,--Y /~---b
- ~
23. DATE 09/23/2002
This license authorizes the marriage in New York State f the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o "checked, this license is to be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR C CLERKJ 25 A SOLEMNIZATION PERIOD BEGINS
na . . .
NAME (PRIN
-
COUNTY Dutchess
CITYfTOWN Wappinger
~~J~kCRT 1368
~5~~l~R 153
1 A FULL NAME
FIRST
"-
N
B BIRTH NAME, IF DIFFERENT .
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)089_70_8075
D SOCIAL SECURITY NUMBER
2 RESIDENCE A. N Y B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY '6 TOWN 0 VILLAGE
~~~CIFY Wappinger
D STREET ADDRESS 302 River Road North ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES '6 NO
12 /01 / 1968
MONTH DAY YEAR
3. A. AGE 33
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Electrical Engineer
8. TYPE OF INDUSTRY OR BUSINESS Warde Electric
5 PLACE OF BIRTH Washington, D. C.
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME Ronald C. Harris
8. COUNTRY OF BIRTH Trinidad And Tobago, West Indies
7. MOTHER
A MAIDEN NAME Berthel D. Brissette
8. COUNTRY OF BIRTH Jamaica, West Indies
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END?
(3) D DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
YEAR
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES 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
a:
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{ SEAL }
'-y-I
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICA~TED.
29 OFFICIANT. />>
NAME (PRIN '""
SIGNATURE.
DOH-98 (11/98)
I
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~
Beverly L Sewell
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Sewell
c. SURNAME AFTER MARRIAGE Sewell - Ht=.l rris
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 123-68-7303
12 RESIDENCE ANY B Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D STREET ADDRESS 302 River Road North ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
04 /11 Aqm
MONTH DAY YEAR
11. A. FULL NAME
13. A. AGE 32
13.B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Mortgage Closing Specialist
8. TYPE OF INDUSTRY OR BUSINESS Ameriquest Mta. Co.
15. PLACE OF BIRTH Belize City, Belize
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Arthur Sewell
8. COUNTRY OF BIRTJ3elize Citv, Belize
17. MOTHER
A. MAIDEN NAME Eleanor Trench
8. COUNTRY OF BIRTHBelize City, Belize
18. NUMBER OF THIS MARRIAGE 2
DEATH
o
TIME
MONTH
25 B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON,
MONTH
DAY
YEAR
YEAR
ZIP
9:04 AM
PM 09
24
2002 11
22 2002
10 CIVIL
28. PLACE WHERE MARRIAGE OCC(\REDr. ( .
A. STATE NEW YORK 8. CO~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
~F.
SPECIFY
SIGNATURE.