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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Steven F. Reynolds
MIDDLE CURRENT SURNAME
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York Sta authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within ew 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.
r-"-.. 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)G_lo . M E MONTH
TIME MONTH Y AR
SEAL SIGNATURE ~
'-y-I "bl~t&a'i~bush Rd 9:44 ~~ 7 09 2002 09 06 2002
STREET ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED
~~~sM~~~~g~B~V;H~/iHRE TIME MO. DAY YEAR
DATE AND AT THE TIME AND
PLACE INDICATED
TITLE PCl ~ tll r
DATE .\Ju ~ta. ~OO~
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COUNT',Qutchess
CITYITOWNWappinger
~~~~~CR" 368
~G~I~J~F95
, A. FULL NAME
FIRST
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B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSIilo99-62 2'A A2
D. SOCIAL SECURITY NUMBER U - .....
2. RESIDENCE ANew York B. Sullivan
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOwN"'D VILLAGE
~~~CIFY Liberty
D. STREET ADDREss11 0 Chestnut Street Apt. 1 ZIP 12754
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? "1:J YES 0 NO
/17 A ~fi~
DAY YEAR
3 A. AGF33
3B. DATE OF BIRTH
n~
MONTH
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4. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINEs~ivingston Manor Central
5. PLACE OF BIRTllibertv New York .
(CIT~,"5"i .(TEiCOUNTRY IF NOT USA)
6. FATHER
A. NAME Fred Reynolds
B. COUNTRY OF BIRTr!) S A
7. MOTHER
A. MAIDEN NAME Doris Scudder
B. COUNTRY OF BIRTHU SA
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
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, STATElCOUNTRY. IF NOT USA) SELF SPOUSE
YEAR
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1ST
2ND
3RD
4TH
I, being duly sworn, depose and S
as to my right to enter into the mar
21. SIGNATURE OF GROOM ~
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29. OFFICIANT
NAME (PRINT)
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
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t/1?1i,{
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L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Carolvn L Figel
MIDoLt - - CURRENT SURNAME
..J
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Reynolds
(OPTIONAL - SEE REVERSE!. 0
D. SOCIAL SECURITY NUMBERlu0-52-3643
12. RESIDENCE ,New York BDutchess
(ST ATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN..() VILLAGE
~~~cIFrWappingers Falls
D STREET ADDREss18 Uss Road zIP12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? "'tJ YES 0 NO
10 .12 147
MONTH OA Y Y~AR
13. A. AG~R
13.B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATIO~ental H'tgienist
B. TYPE OF INDUSTRY OR BUSINES~rs Schwartz" Patten
15. PLACE OF BIRnGowanda New.York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAMDavid Figel
B. COUNTRY OF BIRTIJ ~ A
17. MOTHER
A. MAIDEN NAMEBonnie Plenz
B. COUNTRY OF BIRTlJ ~ A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
n
n
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
o
o
o 0
o 0
o 0
o 0
n egal impediment exists
.....
YEAR
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY ~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF rM'TOWN OF 0
VILLAGE OF
SPECIFY
A ~ Go I'\.l 0...
STATE
31.
NAME (PRINT)