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CITYITOWNWappinger
~~~~k~"'1368
~5~'~J~R1 01
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Patrick M. Howard
I
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
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L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Sharon E. Genest
MIDDLE CURRENT SURNAME
~
1. A. FULL NAME
11. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
"-
N
B BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Howard
(OPTIONAL. SEE REVERSEft "0-68-0408
D. SOCIAL SECURITY NUMBER U<t
12. RESIDENCE ,New York
(STATE) (COUNTY)
C. CHECK ONE 0 CITY'tJ TOWN 0 VILLAGE
AND \AI .
SPECIF""~ applnger
D. STREET ADDRES'J.7 Losee Road
ZIP12590
o YES"''o NO
1873
YEAR
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERS'087 70-4636
D. SOCIAL SECURITY NUMBER -
2 RESIDENCE ANew York B. Dutchess
(STATE) J (COUNTY)
C. CHECK ONE 0 crrv-D TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRES#,7 Losee Road ZIP 12590
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YEs"'D NO
/.26 /t 973
DAY YEAR
B.
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AG~9 13.B. DATE OF BIRTH 03 ;(6
MONTH DAY
3 A. AGt28
07
MONTH
3B. DATE OF BIRTH
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4. EMPLOYMENT
A. USUAL OCCUPATIONCarrnan
B TYPE OF INDUSTRY OR BUSINEs~etro North
5. PLACE OF BIRT~lean. New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Lawrence Howard
B. COUNTRY OF BIRTJJ S A
14. EMPLOYMENT
A. USUAL OCCUPATlorReceptionist
B. TYPE OF INDUSTRY OR BUSINES~olden Eaale Leasing
15. PLACE OF BIRTDanburv. Connecticut
(CITY, STAfBCOUNTRY IF NOT USA)
16. FATHER
A. NAM~ilbet1 Genest
B. COUNTRY OF BIRTlJ S A
17. MOTHER
A. MAIDEN NAM~rsr.e t":suxx
B. COUNTRY OF BIRM S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
7. MOTHER
A. MAIDEN NAME Cynthia Porr.ello
B. COUNTRY OF BIRTHU SA
8 NUMBER OF THIS MARRIAGE'l
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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(2) 0 DEATH
(3) 0 ANNULMENT
/ /
MONTH DA Y 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
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1ST
2ND
3RD
4TH
I, being duly sworn, depose and s ,t
as to my right to enter into the ma la
21. SIGNATURE OF GROOM ~
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22. SIGNATURE OF BRIDE
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23. ~~J:T~~~DO~NT~~~OtRN~~yBgf~i~E DATE 07/12/2002
This license authorizes the marriage in New York person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies withl 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 CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) Gloria Mo se
TIME MONTH YEAR MONTH
SEAL SIGNATURE
'-v-I ~b'1\t~~eYush R 2:07 ~~ 7
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
YEAR
13
2002 09
10 2002
ZIP
l~IL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY \). &\\.QSC)
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF [l('VILLAGE OF
(
SPECIFY
NAME (PRINT)
SIGNATURE ~