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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Peter C. Farrell
CURRENT SURNAME
COUNT~utchess
CITYITOwNWappinger
~~~~kCR" 368
~G~I~J~Rt 44
1. A. FULL NAME
FIRST
MIDDLE
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEill67 62 7727
D SOCIAL SECURITY NUMBER U - -
2. RESIDENCE ANew York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY"'D TOWN 0 VILLAGE
~~~CIFY WappinQer
D STREET ADDRESS 12 Cayuga Drive ZIP 12590
E. IS RESIDENCE WITHiN LIMITS OF CITY OR iNCORPORATED VILLAGE? 0 YES....O NO
Al4 /1970
DAY YEAR
3. A. AG"''\'
38. OATE OF BIRTH
06
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Police Officer
B. TYPE OF INDUSTRY OR BUSINESS Westchester County
5. PLACE OF BIRTJJouQhkeeDsie. New York
(CITY, STATEiCOUNTRY IF NOT USA)
6. FATHER
A. NAME William Farrell
B. COUNTRY OF BIRTHU S A
7. MOTHER
A. MAIDEN NAME Carol Cannova
8. COUNTRY OF BIRTH USA
B. 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) 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
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
o 0
o 0
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
$Jnt It!. rtJ~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Veronica Greany
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Farrell
(OPTIONAL. SEE REVERSE" OO-l:! A 9698
D. SOCIAL SECURITY NUMBER .. o-t-
12 RESIDENCE ANew York B. Dutchess
(STATE) wi!. (COUNTY)
C. CHECK ONE 0 CITY U TOWN 0 VILLAGE
D. :~:~~~:~:S~~e:yuga Drwe
ZIP 12590
.;'
OYESONO
W77
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGe25 13.B. DATE OF BIRTH 06 A 1
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATIONParalegal
B. TYPE OF INDUSTRY OR BUSINEssKaufman, Borgeest, &
15. PLACE OF BIRT~ronx, New YOrk
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAMEJames Greany
B. COUNTRY OF BIRTM S A
17. MOTHER
A. MAIDEN NAME Rosemarv De Luca
B. COUNTRY OF BIRTM S A
lB. NUMBER OF THIS MARRIAGE 1
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
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
o 0
o 0
o 0
the bride and groom named above by any person authorized by New York Domestic
DATE 09/09/2002
er Falls NY 12590
STATE
27. TYPE OF CEREMONY
O~OUS
9 0 OTHER, SPECIFY
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TITLE
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/98)
.---:
\- ....,1-<: \ 14 N l.i,
f\ ::;;-{~
TIME
MONTH
YEAR
ZIP
09:34 AM 09
PM
10 CIVIL
2B. PLACE WHERE MARRIAGE OCCURRjD / Jr
A. STATE NEW YORK B. COUNT~~""
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
/"
~OF 0 TOWN OF 0 VILLAGE OF
SPECIFY V tfVL. t..ep
/
19iC"tj V< ,(1t. V;'C,4/t.
oq / .,21'/ ,J-~L
,
1010
IP
31. WITNESS TO CEREMONY
NAME (PRINT) K. ~ f\. III I ? G () r... yt I~
l..-l.A''-1: ....~A-.-
SIGNATURE ~