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COUNT,Qutchess
CITY/TOWNWappinger
~~~~~CR1368
~~~'~~~F54
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Richard M. Doyl, JR.
CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
/1
h .. i~ ,{/ 1\
I
-Jl11l
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
stefanie B. Cohen
~
11 A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
A FULL NAME
MIDDLE
FIRST
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Cohen - Doyl
(OPTIONAL' SEE REVERSElI56-63-1601
o SOCIAL SECURITY NUMBER 'I
12 RESIDENCE )"Jew York BDutchess
(STATE).L ,COUNTY)
C CHECK ONE 0 CITY U TOWN 0 VILLAGE
AND W .
SPECIF~~ applnger
D STREET ADDRESJ 668 Route 9 Apt. 1 h
ZIp12590
.;
::J YES 0 NO
1911
YEAR
B BIRTH NAME. IF DIFFERENT
3 A AGEl5
06
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE'
13. A AG~4 13B DATE OF BIRTH 12 )t'6
MONTH
DAY
3B DATE OF BIRTH
DAY
MONTH
14 EMPLOYMENT
A. USUAL OCCUPATIONTeacher
B TYPE OF INDUSTRY OR BUSINES~packenklll High School
15. PLACE OF BIRTj-fackensack, New Jersey
(CITY, STATE,COUNTRY IF NOT USA,
4 EMPLOYMENT
A. USUAL OCCUPATION Mailman
B. TYPE OF INDUSTRY OR BUSINEssUnited Sates Post Office
5. PLACE OF BIRTrRhinebeck, New York
(CITY, STATE/COUNTRY IF NOT USA)
16, FATHER
A NAMPaniel Cohen
B COUNTRY OF BIRTM S A
17, MOTHER
A MAIDEN NAMEBarbara Klein
B. COUNTRY OF BIRTM 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
6 FATHER
A. NAME Richard Doyl
B COUNTRY OF BIRTHU S A
7. MOTHER
A MAIDEN NAME Eileen Gritmon
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
B HOW DID LAST MARRIAGE END' (3)::J DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2' ::J DEATH
B HOW DID LAST MARRIAGE END' (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C DATE LAST MARRIAGE ENDED?
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
o 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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23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York St
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 CL.ERK 25. A SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) ~.!? . M
_ TIME MONTH YEAR
SEAL SIGNATURE ~
'-v-I M~ti1.1iifdfe~ush Rd 2:34 AM 05
STREET STATE liP PM
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER- Y
SONS NAMED ABOVE ON THE 0 }Cl RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED 9 [j OTHER, SPECIFY
09 2002
by New York Domestic
MONTH
YEAR
11
2002 07
10 CIVIL
28 PLACE WHERE MARRIAGE OCCURRED
A STATE NEW YORK B COUNTyOr~_C
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
rfsYY OF 0 TOWAN JF 0 VIL7f'E OF
SPECIFY 1I.f ~bu ~
::M;::::~:,:erFI~ ~ Cos,~~
SIGNATURE ~ A QQ . G~ f, ~