107
z z
~ g W
ii! ~ ....
e- Z <(
~ aJ ()
~ sl u::
~ u. i=
~ 0 a:
b ~ W
Iii 0 ()
I- '"
o
z ~
COUNTY Dutchess
CITY/TOWN Wappinqer
~~~~~~T 1368
~5~1~~~R 107
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Richard T. Kennealv. Jr.
MIDDLE CURRENT SURNAME
CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
~tt2t
,j 3 II
r~ ,t~ci1
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kristin N. Fiorito
~
1 A FULL NAME
11. A. FULL NAME
FIRST
FIRST MIDDLE
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT Keebler
c. SURNAME AFTER MARRIAGE Kennealv
(OPTIONAL. SEE REVERSE) 553-23-2064
D SOCIAL SECURITY NUMBER
12 RESIDENCE A. N Y B Dutchess
(STATE) ...J (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN LJ VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDRESS 2585 South Avenue ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? r1 YES 0 NO
11 / 20 /1968
C1.
N
B BIRTH NAME IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 023 64 0221
D SOCIAL SECURITY NUMBER --
2. RESIDENCE A. N Y B. Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY 0 TOWN r!! VILLAGE
~~~CIFY Wappinqers Falls
D STREET ADDRESS 2585 South Avenue
ZIP 12590
E is RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? dYES 0 NO
04 / 22 / 196
MONTH DAY YEAR
13. A. AGE 33
3 A. AGE 34
3B. DATE OF BIRTH
13.B. DATE OF BIRTH
MONTH
DAY
YEAR
....
:>
<(
c
u::
u.
<(
4. EMPLOYMENT
A. USUAL OCCUPATION Financial Manaqer
B. TYPE OF INDUSTRY OR BUSINESS IBM Corp.
5. PLACE OF BIRTH Boston, Massachusetts
(CITY. STATEiCOUNTRY IF NOT USA)
6. FATHER
A. NAME Richard Thomas Kennealy
8. COUNTRY OF BIRTH USA
16. FATHER
A NAME Paul Keebler
B COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Edel'lna Mar'la Trepep'l
8. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 2
14. EMPLOYMENT
A. USUAL OCCUPATION Accountant
8. TYPE OF INDUSTRY OR BUSINESS IBM Corp.
15. PLACE OF BIRTH Poughkeepsie, New York
(CITY. STATE/COUNTRY IF NOT USA)
7. MOTHER
A. MAIDEN NAME Elaine Frances Thurston
B COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
a:
OJ
CD
"
::J
Z
o
Z
0:
e-
:ij
a:
e-
<f)
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
~ ~
8. HOW DID LAST MARRiAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT 2) 0 DEATH B. HOW DiD LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (90 DEATH
C DATE LAST MARRIAGE ENDED? 10/ 03 / 001 c. DATE LAST MARRIAGE ENDED? 09 / 06 / 1 94
MONTH",. DAY YEAR MONTH", DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY. YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH, DAY. YEAR] (CITY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST 10/03/2001 Charlottesville, Virginia D~ 0 1ST 09/06/1994 Poughkeepsie, New York 0 D~
2ND 0 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
knowl dge and belief that the information I provided is true and that I declare that no legal impediment exists
"7/
Yi, I
DEATH
o
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
DEATH
o
YEAR
3RD
4TH
I, being duly sworn, depose and
as to my right to enter into t
21.
07/17/2002
DATE
by New York Domestic
w
en
z
w
()
...J
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 ~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 CLEFJK 25. A. SOLEMNIZATION PERIOD BEGINS
GlOria J. Morse
NAME (PRINT)
YEAR
r-^-,
{ SEAL}
'-v--I
ZIP
08:47AM
PM
07
TIME
MONTH
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
28. PLACE WHERE MARRIAGE OCCURRED ~ J _,
A. STATE NEW YORK B. COUNTY ~f~
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~TOWN OF 0 VILLAGE OF"
SPECIFY e, ~.5 4 l<. ~y.c- I ~
1/!'f. CIVIL
TITLE :r s c... .
DAi} 7 lz.o lO ~
f1 Y I [. 60)
STATE
31.
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/9B)
SIGNATURE ~