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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Terry M. Sandler
MIDDLE CURRENT SURNAME
COuNT-,Qutchess
C1TmowNWappinger
~~~~~CR~ 363
~5~I~J~~6
A FULL NAME
FIRST
B BIRTH NAME IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSOJ 31 60-0727
o SOCIAL SECURITY NUMBER -
2 RESIDENCE AOhio B Summit
C CHECK ONE (S';;~I CITY [J TOWN 0 VILLAGE (COUNTY)
~~~CIFY Akron
o STREET ADDRES~79 8 North Point Drive ZIP 44313
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? .....0 YES 0 NO
/03 /1978
YEAR
3 A
AG~4
02
3B. DATE OF BIRTH
MONTH
DAY
4 EMPLOYMENT
A USUAL OCCUPATION Teacher
B TYPE OF INDUSTRY OR BUSINESSCanton Players Guild
5 PLACE OF BIRTHTarrvtown. New York
(CITY, STATE'COUNTRY IF NOT USA)
6. FATHER
A. NAME Howard Sandler
B. COUNTRY OF BIRTHU S A
7 MOTHER
A. MAIDEN NAME Robin Lindenbaum
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
B HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
C DATE LAST MARRIAGE ENDED?
DEATH
o
(2) 0 DEATH
MONTH DAY YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? eYES 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
USE CURRENT NAME
23 ~~~NS;T~~~DO~NT~~~O~RN~~yBg~:~~ E DATE 0
This license authorizes the marriage in of the bride and groom named above by any person authorized by New
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.
~ 24 TOWN OR CITY CLERK 25. A, SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) Gloria J
TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ AT~5/21/2002
'-y-I ~~~ta~~~ush Y 12590
STREET STATE
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER. - /
SONS NAMED ABOVE ON THE 0 ~ RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICA TED
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SIGNATURE ~ ~ e:. '- ~
MAILING ADDRESS
9 \) Slt,s oS e <( 'f) ((.. , f f+f-t:t:5R <;tJrJ
STREET CITY,TOWN
30. WITNESS TO CEREMONY
Yo....lie...
29 OFFICIANT
NAME (PRINT)
o
[J
o
TITLE
DATE
,..;'/
STATE
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
r
u'li
&.6.t,x
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Stephanie L. Wolfson
MIDDLE CURRENT SURNAME
~
11 A FULL NAME
FIRST
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Wolfson - Sandler
{OPTIONAL. SEE REVERSE119-72 8726
o SOCIAL SECURITY NUMBER -
12 RESIDENCE AOhio BSummit
(STNE) (COUNTY)
C CHECK ONE '1J CITY 0 TOWN 0 VILLAGE
~~~cIFAkron
o STREET ADDRES~79 8 North Point Drive
ZIM3'13
.....CJ YES:::J NO
t9'78
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13 A. AGE23 13.8. DATE OF BIRTH 09 ;(9
MONTH DAY
YEAR
14 EMPLOYMENT
A. USUAL OCCUPATIO$tudent
B. TYPE OF INDUSTRY OR BUSINEs,Kent State University
15 PLACE OF BIRT~ew York. New York
(CITY, STATE'COUNTRY IF NOT USA)
16. FATHER
A. NAME~.tan Wolfson
B COUNTRY OF BIRTW S A
17. MOTHER
A. MAIDEN NAMEElaine Tomei
B COUNTRY OF BIRTIJ S A
18, NUMBER OF THIS MARRIAGE 1
19. 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
C DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DA 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
o
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o
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n
'-"
[~
D
,
22, SIGNATURE OF BRIDE ~
York Domestic
YEAR
ZIP
ApMM 05
2:20
22
2002 07
20 2002
28 PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A, STATE NEWYORK B COUNTY ~\I.. -rtHe,
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
C CITY OF !It'TOWN OF 0 VILLAGE OF
OTHER, SPECIFY
t<-~
(p ! () 7-( 0"\./
L 1..-- )-~ ~
SPECIFY u.) At: f' PIN (i-1,(j\.
ZIP
31. WITNESS TO CEREMONY
",M' 1"'''1 f~~~
SIGNATURE ~ '"