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C';UNTyQulchess
CITYiTOWN Wappinqer
~~~~~CRT1368
~5~'~J~P69
STATE OF NEW YORK
DEPARTMENT OF HEALTH
-AFFIDAVIT, LlCE~NSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Kevin James Watson
I STATE FILE NUMBER I
(THIS SPACE FOR STA TE USE QNL Y)
L~.J 5-iJ
Lo SUPPLEMENTAL FILE ~
11 A FULL NAME
FIRST
FROM THE BRIDE
Jaime Alane Kulas
MIDDLE CURRENT SURNAME
A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B BIRTH NAME. IF DIFFERENT
B BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C SURNAME AFTER MARRIAGE Watson
(OPTIONAL' SEE REVERSEI!-76-27 1925
o SOCIAL SECURITY NUMBER;:) -
12. RESIDENCE ~ew York BDulchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFyWappinger
o STREET ADDRES~119 Princess Circle
zIP12590
DYES "'LJ NO
1918
YEAR
3 A. AGEM
03
MONTH
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13 A AGF23 13.B DATE OF BIRTH 10 ~1
MONTH DAY
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATIO~usiness Professional
B TYPE OF INDUSTRY OR BUSINESs!. B. M
15. PLACE OF BIRTJ:::~~!'s~~!~cPu~T~~F~JJ uS~rolilna
16. FATHER
A. NAMEMichael Kulas
B. COUNTRY OF BIRTlI S A
17 MOTHER
A. MAIDEN NAME~~nrlr~ R~yhnm
B COUNTRY OF BIRTU S A
18 NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENOED BY
DIVORCE CIVIL ANNULMENT
o 0
4. EMPLOYMENT
A USUAL OCCUPATION Professor
B TYPE OF INDUSTRY OR BUSINEssMarist Colleae
5. PLACE OF BIRT~wicklev, Pennsvtvania
(CITY. STATt/COUNTRY IF N~SA)
6 FATHER
A. NAME Charles Watson
B. COUNTRY OF BIRTHU S A
7. MOTHER
A. MAIDEN NAME M~ry Rp.p.ton
B. COUNTRY OF BIRTH USA
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) 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?
(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
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? [] YES C 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
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o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
Y knowledge and belief that the information I provided is true and that I declare that
o
22. SIGNATURE OF BRIDE
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23 SUBSCRIBED AND SWORN TO B FORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York St groom named above by any person authorized by New York Domestic
Relations Law S11 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.
~ 24 TOWN OR CITY CLERK 25 A SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) ~o . M rse TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ ' DATE05/24/2002
'-y-I 1~~ta'itl~13ush Rd i er Falls NY 12590 3".01 ~~ 05 25 2002 07 23 2002
STREET c TOWN STATE ZIP
~~~R~~~R;~~~ 'O~O~~~N~ZEE~ 26 SOLEMNIZATION OCCURRED 27 TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO DAY YEAR aX RELIGIOUS
gt;~E ~~glc":T:~E TIME AND 11 '~AM 9 0 OTHER. SPECIFY
YEAR
10 CIVIL
28 PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUN;;J:l1-eAe~
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF )( TOWN OF 0 VILLAGE OF
SPECIFY E ASI FIsif k tJ. L
TITLE R.C. PAt 1:S-;
b - 'Z.. "L. - 0 'L-
I'-r ..3
Dflf ~E J. L. iTct:
STATE ~P
31 WITNESS TO CEREMONY
29 OFFICIANT{ ~
NAME (PRINT\::
SIGNATURE ~
MAILING ADDRESS
CO"" lJ,AJ A's.
STREET CITY TOWN
'" .,m'" ~MO" ~ \
"M""'''' .., \ J>~ '. 1rI-=...:J
SIGNATURE~ ~ ~~\)~=--- ')
DOH-98 (11/98)
DATE
NAME (PRINT)
SIGNATURE ~
~