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COUNTY Dutchess
CITYITOWN Wappinger
~~~~~CRT 1368
~5~'iJ~R 150
STATE OF NEW YORK.I
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Earl R Libb
MIDDLE C~RENT SURNAME
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
,JjfdS
1~1) c rl
L 0 SUPPLEMENTAL FILE
~
A FULL NAME
II. A. FULL NAME
FROM THE BRIDE
Marie I Tay,!or
MIDDLE CURRENT SURNAME
FIRST
FIRST
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT \.RvRnRgh
C SURNAME AFTER MARRIAGE Taytor - J ihhy
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER 049-6fi-.74n6
12 RESIDENCE A. New York B Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY 0 ~WN 0 VILLAGE
AND
SPECIFY Wappinger
o STREET ADDRESS 4 C:raig Place ZIP 17590
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE' 0 YES 0 ~O
13 A AGE 40 13.B DATE OF BIRTH MONlf / Dl~ / 12~O
B BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 050-50-5128
SOCIAL SECURITY NUMBER ---------
RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
o CITY 0 --fOWN 0 VILLAGE
Hyde Park
o STREET ADDRESS 1864 Route 9 G
C CHECK ONE
AND
SPECIFY
12580
o YES O~O
ZIP
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE'
3B. DATE OF BIRTH
14. EMPLOYMENT
3 A. AGE 46
4. EMPLOYMENT
A. USUAL OCCUPATION Nuclear Operations
B TYPE OF INDUSTRY OR BUSINESS Fntergy
5. PLACE OF BIRTH Newark New .Jer~ey
(CITY, STATE/COUNTRY IF NOT USA)
6 FATHER
A USUAL OCCUPATION Administrative Assistant
B TYPE OF INDUSTRY OR BUSINESS J R M
15. PLACE OF BIRTH (c~!.9f1K't~$;~)~~~A)
16. FATHER
A. NAME I en .Iames \.RvanRgh
B. COUNTRY OF BIRTH I J S 11
17. MOTHER
A. MAIDEN NAME Louise Acampora
B COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 3
19 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
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A. NAME Mervyn Libby
B COUNTRY OF BIRTH I J S A
7. MOTHER
A MAIDEN NAME Elizabeth stevens
B COUNTRY OF BIRTH II S A
NUMBER OF THIS MARRIAGE 7
9 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o
B HOW DID LAST MARRIAGE END' (3) 0 ~ORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 00/"1 / 1Q99
MONTH DA~ Y~lI"
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 v/.s 0 NO
IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATEiCOUNTRY, IF NOT USA) SELF SPOUSE
t::
DEATH
2
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B. HOW DID LAST MARRIAGE END' (3) 0 'diVORCE (3) 0 ANNULMENT (2) 0 DEATH
C DATE LAST MARRIAGE ENDED? O~ 27 / 1 Q99
MONTH DA Y YE~i1'""
D ARE ANY FORMER SPOUSE(S) ALIVE? O.,(S 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION 20.
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
09127/1999 Martin County Florida 0 J 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
ge and belief that the information 1 provided is
21 SIGNATURE OF GROOM ~
1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, that to the best of my n
as to my right to enter into the marriage state.
o~/~~/~~g~ g~ni'bUry, Connectic1Jt '1\ 0
~,', ' he~s COIlnty, Ne'lll'ft~ c
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23 SUBSCRIBED AND SWORN TO BEFORE E
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York Stat
Reiations Law 911 to perform marriage ceremonies within w 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
DATE
by New York Domestic
~
{ SEAL }
'-v-'
YEAR
MONTH
YEAR
TIME
MONTH
111n~j{"nn
DATE
AM
03' 3M
11
10
20 1 01
08 2001
ZIP
STATE
27. TYPE OF CEREMONY
o J:il RELIGIOUS
9 0 OTHER, SPECIFY
N
ITY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY D..iclt(~
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF D( TOWN OF 0 VILLAGE OF
10 CIVIL
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29. OFFICIANT
NAME (PRINT)
TITLE
/{e IJ<".-e",d
I;l-/IY /0 (
, 2-';-70
ZIP
31 WITNESS TO CEREMONY
SPECIFY
t)CI-~III;'U.r
I r.
DATE
l c..) ''<)r i::
STATE
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/98)
SIGNATUR