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COUNTY Dutchess
CITYfTOWN Wappinoer
8~J~~~T 1368
~G~~~~R 72
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDA VIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Ja11J'~~E Ronald S~~~R~SURNAME
FIRST
I
STATE FilE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
{)i/1~
h!tltJ~'
1 A FULL NAME
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Diane K Finek
MIDDLE CURRENT SURNAME
-1
FIRST
11 A. FULL NAME
a.
N
B BIRTH NAME. IF DiFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 55 57 68""' 1
o SOCIAL SECURITY NUMBER 4- - f
2 RESIDENCE A. New York B Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY EY'TOWN 0 VILLAGE
~~~CIFY Beacon
o STREET ADDRESS 17 F Van Cortland Circle ZIP 12508
8 BIRTH NAME (MAIDEN NAME), iF DIFFERENT
C SURNAME AFTER MARRiAGE Finek
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER 095-70-::' 709
12. RESIDENCE A. New York B Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY O"'TOWN 0 VILLAGE
~~~CIFY Beacon
o STREET ADDRESS 17 F Van Cortland Circle ZIP 12508
E is RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES D'" NO
13 A AGE ?O 13.B. DATE OF BiRTH 01 / 10 /1 !='lR?
MONTH DA Y YEAR
E is RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r"I NO
O~ / ii/1m
MONTH DAY YEAR
3 A AGE 23
38. DATE OF BIRTH
4 EMPLOYMENT
A USUAL OCCUPATiON Military
B TYPE OF INDUSTRY OR BUSINESS U S Marine Corps
5 PLACE OF BiRTH San Clemente, California
(CITY, STATE!COUNTRY IF NOT USA)
14. EMPLOYMENT
A USUAL OCCUPATiON Student
B. TYPE OF INDUSTRY OR BUSINESS Marist Colleoe
15. PLACE OF BIRTH NewburQh, New York
(CITY, ST A TE!COUNTRY IF NOT USA)
6. FATHER
A. NAME James B. Swope
B. COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Loree Mowry
B. COUNTRY OF BIRTH USA
NUMBER OF THIS MARRIAGE 2
16. FATHER
A NAME Branko Finek
8. COUNTRY OF BIRTH YUQoslavia
17. MOTHER
A. MAIDEN NAME Michelle Mc Dowell
B. COUNTRY OF BIRTH USA
lB. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) dDIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C DATE LAST MARRIAGE ENDED? 07 / 18 / 2000
MONT~ DAY
D ARE ANY FORMER SPOUSE(S) ALIVE? UYES 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
07/18/2000 Vista California
DEATH
o
8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
c. DATE LAST MARRIAGE ENDED?
YEAR
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DA Y
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
YEAR
1ST
2ND
3RD
4TH
I, being duly Sworn, depose and say, that
as to my right to enter into the marriage
o c!'" 1 ST
o 0 2ND
o 0 3RD
o 0 4TH
Y knowledge and belief that the information I provided is true a
o
o
o
21 SIGNATURE OF GROOM ~
23 SUBSCRIBED AND SWORN TO B RE ME
SIGNA TURE OF TOWN OR CITY LERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law S11 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 CLE'3K 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) GlOria J. Morse
{TIME MONTH YEAR MONTH
SEAL SIGNATUR~ ~ DATE 05/30/2002
'-v-' MA~tfMitrM~bush ,W in er Falls, NY 12590 12:~~ 05 31 200 07 29 2002
STREET CITY/TOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER- . /
SONS NAMED ABOVE ON THE RELIGIOUS 1 ~IVIL
DATE AND AT THE TIME
PLACE INDICATED
YEAR
9 0 OTHER, SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNT~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF iYVILLAG~ I~
SPECIFY ~/W:s,118::t!J1&
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
NAME (PRINT)
SIGNATURE ~