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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Daniel Matthew Hannon
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYITOWN WappinQer
~~~~kCRT 1368
~5~I~J~R 1 08
1 A. FULL NAME
FIRST
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B Dutchess
(STATE).J (COUNTY)
C. CHECK ONE 0 CITY t.::l TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
o STREET ADDRESS 19 Sherwood Drive ZIP' 12603
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
08 / 12 / 197
MONTH DAY YEAR
068-66-4933
3. A. AGE 30
3B. DATE OF BIRTH
4. EMPLOYMENT
A USUAL OCCUPATION Telephone Technician
B TYPE OF INDUSTRY OR BUSINESS Verizon
5. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME Peter L. Hannon
B COUNTRY OF BIRTH U S A
7. MOTHER
A. MAIDEN NAME Florence Caviolo
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
DEATH
o
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
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
4t1t
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L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Leisa Ann Schatz
~
11 A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Schatz - Hannon
(OPTIONAL - SEE REVERSE) 114-52-6737
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B Dutchess
(STATE) -.J (COUNTY)
C. CHECK ONE 0 CITY L.r TOWN 0 VILLAGE
~~CIFY Poughkeepsie
D STREET ADDRESS 19 Sherwood Drive ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
02 /17 /1962
DAY
13. A. AGE 40
13.B. DATE OF BIRTH
MONTH
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Registered Nurse
B. TYPE OF INDUSTRY OR BUSINESS E::den Park Health Care
15. PLACE OF BIRTH poughkeepsie, New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Robert J, Schatz
B. COUNTRY OF BIRTH USA
17. MOTHER
A MAIDEN NAME Frances Shirley Pontzer
B. 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
DEAOH
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
o
o
o
o 0
o 0
o 0
o 0
pediment exists
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1ST
2ND
3RD
4TH
1, being duly sworn, depose and . thaI 10 I
as 10 my right to enter into the marn
21. SIGNATURE OF GROOM ~ /
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11to 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 LEF3K 25. A. SOLEMNIZATION PERIOD BEGINS
~Ia J.
o 0 RELIGIOUS
()2.. 9 0 OTHER, SPECIFY
CE:..~E- TITLE fP/!JfIE/l Jav.uJ:srJM J
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/1 ItE<~P~OII2 TL., {/rJ,4/Jt0iV~ MJ.kS /VJ. 17$0
CITYITOWN STATE
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{ SEAL }
'-.t-"
NAME (PRINT
-
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED A80VE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29 OFFICIANT
NAME (PRINT)
r..
NAME (PRINT)
i
SIGNATURE ~
DOH-98 (11/98)
OA
by New York Domestic
TIME
MONTH
ZIP
AM
02:33pM
07
28. PLACE WHERE MARRIAGE OCCURRED
1 itjt CIVIL
A. STATE NEW YORK B. COUNTY Ptlrc JI~~s
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF "'j( TOWN OF 0 VILLAGE OF
SPECIFY f/ ~c= PI9I2K
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) ~ /J/I/'
SIGNATURE ~
E