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COUNT.):)utchess
cln .mwNWappinger
~~~~kCRJ>t 368
~5~1~~~RJ' 4
STATE OF NEW YOHK.
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Andrew H. Hamilton
FIRST
(THIS SPACE FOR STATE USE ONL Y)
,tU/lt,
!o.!tt)~
L [J SUPPLEMENTAL FILE
FROM THE BRIDE
Karen Annette Lee
MIDDLE CURRENT SURNAME
~
11 A. FULL NAME
A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
BIRTH NAME. IF DIFFERENT
B BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C SURNAME AFTER MARRIAGE Lee - Hammon
(OPTIONAL - SEE REVERSElt42 11 1649
o SOCIAL SECURITY NUMBER I - -
12 RESIDENCE ,New York BDutchess
(STATEI (COUNTY)
C CHECK ONE C CITY ~ TOWN 0 VILLAGE
~~~CIFyWappinQer
o STREET ADDREss123 Widmer Road Apt. 2 B Z1P12590
3 A
AGE33
06
MONTH
C YES~ NO
1-974
YEAR
E IS RESIDENCE WITHIN liMITS OF CITY OR INCORPORATED VILLAGE'
13 A_ AGF28 13.8 DATE OF BIRTH 05 ,,11
MONTH DAY
3B DATE OF BIRTH
14 EMPLOYMENT
A_ USUAL OCCUPATIO~ashion Desianer
8. TYPE OF INDUSTRY OR BUSINESsllnemployed
15. PLACE OF BIRTrSt. Andrew, Jamaica
(CITY. STATE,COUNTRY IF NOT USA)
4 EMPLOYMENT
A USUAL OCCUPATIONEquipment Service
B TYPE OF INDUSTRY OR BUSINESsNorthwest Airline
5 PLACE OF BIRT~t. Thomas
(CITY, STATE'COUNTRY IF NOT USA)
16 FATHER
A NAM~ames Lee
B. COUNTRY OF BIRTKintyre, Jamaica
17 MOTHER
A MAIDEN NAMEVinneth Fnrhe!';
B. COUNTRY OF BIRTGuyS Hill St Catherine, Jamaica
18 NUMBER OF THIS MARRIAGE 1
19_ PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
6_ FATHER
A. NAME Kinq Hamifton
B. COUNTRY OF BIRTHJamaica
7 MOTHER
A MAIDEN NAME Myrtle Carr
B COUNTRY OF BIRTH Jamaica
8 NUMBER OF THIS MARRIAGE 1
9 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END' (3) [] DIVORCE
C_ DATE LAST MARRIAGE ENDED?
(3) [] ANNULMENT
/ /
(2) ~ DEATH
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
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 OA y 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
1ST
2ND
3RD
4TH
I, being duly sworn, depose and sa
as to my right to enter into the ma
21 SIGNATURE OF GROOM~.
o 1ST C
o 2ND C
o 3RD []
iJ 4TH C
d belief that the information I provided is tru~lnd th~t I declare that no le~al impediment exists
22 SIGNATURE OF BRIDE ~ /M"cc~ J t? ~ .
USE CU~1l1iME
DATE 05/31/2002
w
CJ)
Z
W
(.)
:::i
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 S11 to perform marriage ceremonies within ew York State_ THIS LICENSE VALID IN NEW YORK STATE ONLY.
[] 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) G_IO . . M
TIME YEAR MONTH
SEAL SIGNATURE ~
'-v-' ~bl~fa~e~ush Rd 0:48 AM 6
STREET ZIP PM
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
YEAR
01
2002 07
30 2002
28_ PLACE WHERE MARRIAGE OCCURRED
1 rA CIVIL
A. STATE NEW YORK B COUNTY lJr/{1';lt::4\
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF l'{ TOWN OF C VILLAGE OF
SPECIFY /I)lff!O/I'Ib!.612...
29 OFFICIANT
NAME (PRINT)
SIGNATURE ~
SIGNATURE ~
DOH.98 (11/98r
ZIP
31 WITNESS TO CEREMONY ""/:
~ti;Js. vJ
NAME (PRINT) _l5rJ 'f),
SIGNATURE ~