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A FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
William J. Ryan
FIRST MIDDLE CURRENT SURNAME
I
STATE FilE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
COUNl Y Dutchess
CITY/TOWN Wappinger
~~~~~CRT 1368
~5~I~J~R 93
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L D SUPPLEMENTAL FILE
FROM THE BRIDE
Delores A. Nixon
11. A. FULL NAME
CURRENT SURNAME
U-
N
B BIRTH NAME, IF DIFFERENT
FIRST MIDDLE
BIRTH NAME (MAIDEN NAME), IF DIFFERENT Melta
C SURNAME AFTER MARRIAGE Nixon
(OPTIONAL. SEE REVERSE) 081-30-1663
o SOCIAL SECURITY NUMBER
12. RESIDENCE A New York B Dutchess
(STATE) '" (COUNTY)
C CHECK ONE 0 CITY 0" TOWN 0 VILLAGE
~~~CIFY Wappinger
D STREET ADDRESS 6 Rhymney Road, Apt. 1
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 720-09-5031
o SOCIAL SECURITY NUMBER
RESIDENCE A New York B Dutchess
(STATE) ~ (COUNTY)
C CHECK ONE 0 CITY Ll TOWN 0 VILLAGE
~~~CIFY WaPein~er
STREET ADDRESS R ymney Road, Apt. 1
12524
ZIP 1LOL4
'"
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? [I YES [] NO
13 A AGE 64 13.8. DATE OF BIRTH 03 / 13 /1938
ZIP
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 6 NO
06 / 29 / 192
MONTH DAY YEAR
3. A. AGE 81
38. DATE OF BIRTH
MONTH
DAY
YEAR
4. EMPLOYMENT
A USUAL OCCUPATION Retired
B TYPE OF INDUSTRY OR BUSINESS
5. PLACE OF BIRTH New York, New York
(CITY, STATE/COUNTRY IF NOT USA)
14, EMPLOYMENT
A. USUAL OCCUPATION Library Assistant
B. TYPE OF INDUSTRY OR BUSINESS East Flshklllllbrary
15, PLACE OF BIRTH Newburgh, New York
(CITY, STATE/COUNTRY IF NOT USA)
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6. FATHER
A. NAME William A. R~n
B. COUNTRY OF BIRTH U S
7, MOTHER
A. MAIDEN NAME AnQe/ina Dauer
El COUNTRY OF BIRTH USA
8 NUMBER OF THIS MARRIAGE 3
16. FATHER
A, NAME Anthony Melta
8. COUNTRY OF BIRTH USA
17, MOTHER
A. MAIDEN NAME Mary Costanza
B, COUNTRY OF BIRTH USA
2
18 NUMBER OF THIS MARRIAGE
DEATH
o
19. PREVIOUS MARRIAGES
A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL AN~LMENT
DEA{H
.,
1(~EATH
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9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
2 0
B. HOW DID LAST MARRIAGE END? (3) D" DIVORCE (3) [] ANNULMENT 1200sEATH B, HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANgLMENT
C DATE LAST MARRIAGE ENDED? 08 / 07 / C, DATE LAST MARRIAGE ENDED? 08 / 1 /
MONTH", DAY YEAR MONTH rjjtA Y
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 ANNUL ED, 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, YEA'3/. (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
02/04/194r Jamaica, Queens, New 0 0'" 1ST 0 0
08/07/1995 Poughkeepsie, New York 0'" 0 2ND 0 0
o 0 3RD 0 [J
o 4TH 0 0
d belief that the information I provided is true and that I declare that no legal impediment exists
YEAR
:])j!.1e~ h-t..-.I--IrY1../
<.1. USE CURRENT NA~E -r~' -
DATE 07/01/2002
~
SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE bF.,1t>\(IjN Ql/1 CITY CLERK ~
This Jice se authorizes the marriage in New York State of the bride and groom named above by any person authorized
REl~tibns Law ~11 to perform marriage ceremonies within New York State, THIS LICENSE VALID IN NEW YORK STATE ONLY,
WOlf checked, this license is to be used only for the purpose of a second or subsequent ceremony,
(/)
Z ~ 24 TOWN OR CITY,CLEf!K 25, A. SOLEMNIZATION PERIOD BEGINS
W - . }., NAME (PRINT) GlOria J. Morse
o { TIME MONTH
:;:j . SE'A,L .-'~I~N~TU~E ~ . DATE 07/011200
.' ~ _' :~AI~~~P(J&1~bush Rd, Wappinger Falls, NY 12590 12:1~~ 07
STREET CITY/TOWN STATE ZIP
I CERTIFY THAT I SOLEt-1N1ZEO 26 SOLEMNIZATION OCCURRED 27 TYPE OF CEREMONY
THE MARRIAGE OF l'HE PER.
SONS NAMED ABOVE ON THE TIME MO, DAY YEAR 0 0 RELIGIOUS
DATE AND AT THE TIME AND AM
PLACE INDICATED PM
by New York Domestic
28, PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B COUNTY
9 0 OTHER, SPECIFY
C, LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
29. OFFICIANT
NAME (PRINT)
TITLE
o CITY OF C TOWN OF 0 VILLAGE OF
SIGNATURE ~
MAILING ADDRESS
DATE
SPECIFY
STREET
30. WITNESS TO CEREMONY
CITY/TOWN
STATE
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
NAME (PRINT)
SIGNATURE ~