110
>-
z
UJ
(f)
UJ.
ID
g
:J
o
I
(f)
Z
o
i=
<<
c:
>-
(f)
<3
UJ
c:
UJ
"
<<
a:
c:
<<
::!'
"'-
o
UJ
>-
<<
o
u:
i=
c:
UJ
o
UJ
c:
UJ
I
:;:
(f)
(J)
UJ
c:
o
o
<<
>-
"'-
o
UJ
"-
(J)
z Z
c: 0 W
:J i=
>- ~
UJ <<
c: N <(
>- Z
(J) ::!' ()
:J UJ
::!' 6 i!
>- (f)
z ~
<< "'-
0 0 a:
u:
~ (J) W
>-
<< ()
w 0
.... '"
0
z ~
COUNTY Dutchess
CITYrrOWN Wappinqer
~~~~~CRT 1368
~5~I~J~R 110
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Craig M. Gander
MIDDLE CURRENT SURNAME
I
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
~.t/f(,t
/1
7- ~t7 ~ /){,(
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Ellen E. Jennings
MIDDLE CURRENT SURNAME
~
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
"-
N
B BIRTH NAME. IF DIFFERENT
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Gander
(OPTIONAL - SEE REVERSE) 080 48 0239
o SOCIAL SECURITY NUMBER --
12. RESIDENCE A. N Y B. Dutchess
(STATE) ~ (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN LJ VILLAGE
~~~CIFY WapPin~ers Falls
o STREET ADDRESS 21 chool Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
06 /10 /1970
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 080 68 3671
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. N Y B Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFY WappinQers Falls
D. STREET ADDRESS 21 School Street
12590
YES ~ NO
/ 197
YEAR
YEAR
ZIp.
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
10 / 07
MONTH
13. A. AGE 32
3 A. AGE 26
13.8. DATE OF BIRTH
38. DATE OF BIRTH
DAY
MONTH
DAY
4. EMPLOYMENT
A. USUAL OCCUPATION H V A C Technician
B. TYPE OF INDUSTRY OR BUSINESS Wolfe Plumbing & Heating
5 PLACE OF BIRTH Buchanan, New York
(CITY, STATEiCOUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Social Worker
B TYPE OF INDUSTRY OR BUSINESS Dutchess County
15. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATEiCOUNTRY IF NOT USA)
16, FATHER
A NAME Kenneth J. Jennings, Jr.
B. COUNTRY OF BIRTH USA
17, MOTHER
A. MAIDEN NAME Kathleen A, Tait
8. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEOH
~
:>
<(
c
",i!
:su.
~<(
z
~
o
>-
>'
>-
13
6. FATHER
A. NAME Thomas Gander
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Lynn Bleakley
8. 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
DEATH
o
8. 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
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
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
a:
w
III
"
:J
Z
o
z
'"
>-
~
a:
>-
<f)
18T 0 0 18T 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I, bemg duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true arlttthat I declare that no legal Impediment eXists
as to my right to enter into the mar' ge sta~ ~~
21 SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~ -' CURRENT N E
23 SUBSCRIBED AND SWORN TO BEFORE ME 07/18/2002
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
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 ~11 to perform marriage ceremonies within New York State, THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLEflK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Glor ,Morse
{ ~~
SEAL SIGNATURE ~ 08:3
'-v-' M~~roo f~bush R 200 09 16 2002
STREET ZIP
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
w
en
z
w
()
::::i
YEAR
STATE
27. TYPE OF CEREMONY
o ~GIOUS
9 0 OTHER, SPECIFY
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURR~
A. STATE NEW YORK B. COUNTY~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) .
o CITY O~. 7' TOWN OF ~GE OF
SPECIFY VVIJfHNQ:R.s r-~s
..<: ~~ 7 <.7,J
~~~:f~9i~~T 11~5" fi.htlWci~? $f""" "'" A'.~. t'/Cli<;~
SIGNATURE~ _' ~fJ ~ DATE //6t7/~2-
MAILING AD9RESS /. I r::, I'
I ( Lt iN Tl:i tV S T-, V1./,ftfiJIN~S r~ IVy
STREET CITyrrOWN STAlIE
30. WITNESS TO CEREMONY
betX' e,
NAME (PRINT)
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
SIGNATURE ~