151
] STATE OF NEW YORK I STATE FILE NUMBER I
COUNTY Dutchess (THIS SPACE FOR STATE US~ ONL Y)
CITY/TOWt-J, Wappinger DEPARTMENT OF HEALTH nt q,~~.O
DISTRICT1..J68 AFFIDAVIT, LICENSE and /Ji
NUMBER
REGISTER 151 CERTIFICATE OF
NUMBER
MARRIAGE Lo SUPPLEMENTAL FILE ~
FROM THE GROOM FROM THE BRIDE
1 A. FULL NAME Shawn P. Loughran 11 A. FULL NAME Jennette Alves
FIRST MIDDLE CURRENT SURNAME FIRST MIDDLE CURRENT SURNAME
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B BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Louahran
(OPTIONAL - SEE REVERSE)085-68 ')906
D. SOCIAL SECURITY NUMBER -..J
12, RESIDENCEA.New York B, Dutchess
c, CHECK ONE (STAg) CITY ~ TOWN 0 VILLAGE (COUNTY)
~~~CIFY East FishkiIJ
D. STREETADDREss664 Route 376 ZIP 12533
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ti NO
/22 ~BO
DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE'l33 74-5806
D. SOCIAL SECURITY NUMBER -
2. RESIDENCE A. New York B Dutchess
(STATE) vi.- (COUNTY)
C. CHECK ONE 0 CITY l.J TOWN 0 VILLAGE
~~~CIFY Wappinger
D STREET ADDRESS 54 ~pook HI" Road
ZIP 12590
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E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 NO
10 /17 /1977
DAY YEAR
3. A. AGE24
13. A. AGE22
13.B. DATE OF BIRTH
06
MONTH
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Alarm Technician
B. TYPE OF INDUSTRY OR BUSINESS c. I. A.
5. PLACE OF BIRTHBrooklyn, New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Thomas LOU~hran
B. COUNTRY OF BIRTH U S
7. MOTHER
A. MAIDEN NAME VMen Dunn
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL AO'ULMENT
14. EMPLOYMENT
A. USUAL OCCUPATION Sales Associate
B. TYPE OF INDUSTRY OR BUSINESS H & M
15. PLACE OF BIRTH New Rochelle, New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Jose Alves
B. COUNTRY OF BIRnPortugal
17. MOTHER
A. MAIDEN NAME Maria Alves
B. COUNTRY OF BIRTJ'ortugal
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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
I, being duly sworn, depose and 5
as to my right to enter into the m
21. SIGNATURE OF GROOM ~
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
t of my knowledge and belief that the information I provided is true and that I d
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23. SUBSCRIBED AND SWORN TO BEFOR E
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State f the bride and groom na ed above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within N York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If cheeked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLFRK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) c:'ona J. ~Morse TIME MONTH YEAR MONTH
SEAL SIGNATURE~";' fJ TE09/19/2002
~ ~~!!:Ml_&USh Rd, C fT~!allS, N~TA~E2590 ZIP ~~ 09 20 2002 11 18 2002
~~~R~~~R;~~~ IO~O~~~N~ZEE~ 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 KRELlGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND <t!J,'
PLACE INDICATED. :::> c!)9 20 02.. 9 0 OTHER, SPECIFY
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY 1>V]CJjiSf
29 OFFICIANT~JA~/J D~~
NAME (PRINT) . 'VI ~ v-.' /1/ TITLE
SIGNATURE ~ _ ~ _ .;('~ _ DATE
MAILING ADORE
!2.. JjMV"i.'! $/JT</l.4fr t1Y ~ f'Pf<-K. ~ NY
STREET CITY/TOWN . STATE
30. WITNESS TO CEREMONY
NAME (PRINT) ;11/d,,:ud 7C-IA.
"'. t't' / / ~....4fI
SIGNATURE~ ~ ~
DOH-98 (11/98)
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF l( TOWN OF 0
VILLAGE OF
f/bmM ~(Jc. PPJ
~~M .2o.2.0c2...
,
, 25:Y
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) Axv'\ N -PQ 0 \ \ C.e \l \
SIGNATURE ~ . ~ ~;)) ~ (' ~ j :,
SPECIFY
f.Mr rlSil J<j l.l-
C ,**WM-L \IVtJc-7ltN)