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1. A. FUll. NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christooher John Horton
FIRST MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(TH/S SPACE FOR STATE USE ONLY)
I
COuNnQutchess
CITYrrOWNWappinger
~~J:~~ 368
~5~I:J~~ 1
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Cassandra Ann Tatten
~
11. A. FULL NAME
MIDDLE
CURRENT SURNAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEl11_70-4285
D. SOCIAL SECURITY NUMBER!
2. RESIDENCE ANY B. Oranoe
(ST~TE) (COUNlY)
C. CHECK ONE "'0 CITY 0 TOWN 0 VILLAGE
~~~CIFY Newburoh
D. STREET ADDRESS Unit 12 408 Carpenter Ave ZIP 12550
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 'lI"0 YES 0 NO
3. A. AGF33 3B. DATE OF BiRTH 06 /28 /1976
MONTH DAY YEAR
B. BIRTH NAME (MAIDEN NAMEIJF DIFFERENT
C. SURNAME AFTER MARRIAG~orton
(OPTIONAL - SEE REVERS€>53-74-7506
D. SOCIAL SEfY'1TY NUMBER
12. RESIDENCE ~ prange
(~TE) (COUNTY)
C. CHECK~~E b 0 e.ITY 0 TOWN 0 VILLAGE
~~~CI~~ew urgll
Unit -12 408 Carpenter Ave 12550
D. STREET ADDRESS JP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPO~~ VIll.AGE.2,,., 0 Yf~~ONO
13. A. AGt?9 3B. DATE OF BIRTH f!:!. ~
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESsEducation
5. PLACE OF BIRT~ort Chester, Ny
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Victor Herbert Horton Sr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Joan Marie Goodliffe
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARFjIAGE 1
9. ~~~~~~~R~FR~I('~8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATloJeacher
;fducat'on
B. TYPE OF IND}J.STRY OR ,&S~S
15. PLACE OF BIRT~oncor, ass
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAMfrancis Maurice Tatten
'B. COUNTRY OF BIRTW ~ A
17. MOTHER B
A. MAIDEN NAM~arbara Lynn ersey
B. COUNTRY OF BIRTW ~ ~
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
~VORCE CIVIL AfjNULMENT
DEtTH
DEATH
o
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
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.-.- YEAR
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I duly swear/affirm, Clep'ose and S
as to my right to enter into the r
21. SIGNATURE OF GROOM.
o 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
dge and belief that the Information I provided is true and that I declare that no legal impediment exists
2. SIGNATURE OF BRIDE. ~ ~~. ~J
. USE CURRENT NAME 04/30/2-01 0
DATE
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE M
SIGNATURE OF TOWN OR CITY CLERK.
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New 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) John C. Master
{ 10 YEAR
SEAL SIGNATURE." DATE 04/30/20
'-v-I MA~IBGrOO~df~bu h Rd, Wappingers Falls, NY 12590
STREET CITYITOWN STATE ZIP
~~~R~:RT~~J 'o~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TI E MO. AY YEAR 00 RELIGIOUS 1)1' CIVIL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
by New York Domestic
YEAR
06
29 2010
29. OFFICIANT
NAME (PRINT)
TITLE TOWN J STICE
10
1-20.55
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY OrIUl~-e...
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ]a{ TOWN OF 0 VILLAGE OF
SPECIFY (J a. Wa J 0 fIl d 0-...
SIGNATURE.
MAILING ADORE
{;' I III eG
NAME (PRINT)
SIGNATURE.
NAME (PRINT)
SIGNATURE.