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COUNTY Dutchess
CITYITOWN Wappinger
~~~~~CRT 1368
~5~I€J~R 62
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
William L. Hunt
CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
IJf1tt !J' Ref' tJ ~
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Cassandra J. Casey
MIDDLE CURRENT SURNAME
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11 A. FULL NAME
FIRST
A. FULL NAME
MIDDLE
FIRST
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Hunt
(OPTIONAL. SEE REVERSE) 086-62 0172
o SOCIAL SECURITY NUMBER -
12 RESIDENCE A. N Y B Dutchess
c. CHECK ONE (STA8) CITY 0 TOWN d VILLAGE (COUNTY)
~~~CIFY Wappingers Falls
o STREET ADDRESS 97 Market street ZIP 12590
E is RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
12 /20 /1975
MONTH DAY
tL
N
BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 133-64-8580
o SOCIAL SECURITY NUMBER
2 RESIDENCE ANY B Dutchess
(STATE) J (COUNTY)
C CHECK ONE 0 CiTY 0 TOWN 0 VILLAGE
~~~CIFY Wappingers Falls
o STREET ADDRESS 97 Market Street ZIP 12590
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? dYES 0 NO
12 / 20 / 196
YEAR
13 A. AGE 26
13.B. DATE OF BIRTH
3 A AGE 36
YEAR
38 DATE OF BIRTH
MONTH
DAY
14. EMPLOYMENT
A. USUAL OCCUPATiON Pre-school Teacher
B TYPE OF INDUSTRY OR BUSINESS Humpty Dumpty Day Care
15 PLACE OF BIRTH Port Chester, New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A NAME John Thomas Casey, Jr.
8 COUNTRY OF BIRTH USA
17. MOTHER
A MAIDEN NAME Alfreda Liebman
8 COUNTRY OF BIRTH USA
18 NUMBER OF THIS MARRIAGE 1
19 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
4. EMPLOYMENT
A. USUAL OCCUPATION Publishing
B TYPE OF INDUSTRY OR BUSINESS Consumer Reports
5 PLACE OF BIRTH Mt. Kisco, New York
(CITY, STATE/COUNTRY IF NOT USA)
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6. FATHER
A NAME John Hunt
B COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Marilyn Mitchell
B COUNTRY OF BIRTH USA
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)::J ANNULMENT
C DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES ::J 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
DEATH
o
DEATH
o
(2) 0 DEATH
B HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(21 0 DEATH
MONTH OAY 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
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1 ST 0 0 1 ST [J :=
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH u 0
I, being duly sworn, depose an~s th t to th'e best 0 knowledge and belief that the information I provided is true and that I declare that no legal a'm ediment exists
as to my right to enter into the . ~ ~ ~ ~
21 SIGNATURE OF GROOM ~ ~ U2 SIGNATURE OF BRIDE ~ ~ ,.~
US RRENT NAME ~' USE CURRENT NA
23 SUBSCRIBED AND SWORN TO BEFORE ME J1.<"L_ 05/17 02
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State of !lie bride and groom named above by any person authorized by New York Domestic
Relations Law 911 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
r, If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
24 TOWN OR CITY CLEBK 25. A. SOLEMNIZATION PERIOD BEGINS
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{ SEAL }
'-y-I
YEAR
MONTH
YEAR
TIME
MONTH
NAME (PRINT
-
DATE 05/17/2002
d, W ppinger Falls, NY 12590
CITYcTOWN STATE
27. TYPE OF CEREMONY
10:38AM
PM
G7
~6 2002
05
~8
200
ZIP
l~IL
2B PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNT~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~AGE OF
W4fA~
SPECIFY r 14_ .
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDIC
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
NAME (PRINT)
SIGNATURE ~ .
DOH-98 (11/98)
NAME (PRINT)
SIGNATURE ~.