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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FIRST JosOI~D~E David St~~R~~ SURNAME
COUNTY Dutchess
CITYITOWN Wappinoer
~~~:~c: 1368 .
~5~:~~R 44
1. A. FULL NAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)OO 1 84 5562
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY..o TOWN 0 VILLAGE
~~~CIFY Fishkill
D STREET ADDRESS 648 RockV Glen Rd ZIP 12508
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES"D NO
3. A. AGE ?4 3B. DATE OF BiRTH 01 /24 /1986
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Photographer
B. "TYPE OF INDUSTRY OR BUSINESS Owl Eve Studios
5. PLACE OF BIRTH Carmel. NY
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Adam Keller Strong
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Caroline Sahle
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. ~~~~~~~R~r~h~8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
Lo
~
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, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
SUPPLEMENTAL FILE
FROM THE BRIDE
Tricia Lynn Prisco
MIDDLE CURRENT SURNAME
11. A FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Strono
(OPTIONAL - SEE REVERSE1 03-74-7964
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANY B.Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY '6 TOWN 0 VILLAGE
~~~CIFYFishkill
D. STREET ADDRESp48 Rocky Glen Rd
ZIP 12508
o YEStJ NO
)'986
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE23 3B. DATE OF BIRTH 05 .-l4
MONTH DAY
14. EMPLOYMENT
A. USUALOCCUPATIONChild Care
B. TYPE OF INDUSTRY OR BUSINESsArlington School Distnct
15. PLACE OF BIRTHPoughkeepsie, NY
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAMEWayne J, Prisco
'B. COUNTRY OF BIRT~ S A
17. MOTHER
A. MAIDEN NAME JoAnn T. Davis
B. COUNTRY OF BIRT~ 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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
..- YEAR
C. DATE LAST MARRIAGE ENDED?
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) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
i
z
o
~
!
o 0 1ST
o 0 2ND
o 0 SRD
o 4TH
d belief that the information I provided is tr
o 0
o 0
o 0
o 0
o gal impediment exists
23. SUBSCRIBED AND SWORN TOIA FIRMED
SIGNATURE OF TOWN OR CITY ERK ~
This license authorizes the m In New York State of th bride and groom named above by any person
Relations Law ~11 to perform marriage ceremonies withi New Yor ate. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is 0 e used only for the purpose Df a second Dr subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRIND John C. Masterson
TIME MONTH YEAR
SEAL SIGNATURE ~ DATE 05/03/2010
I- -.J MAI1.!IiG }.~IPdBI;l?eS b
-v- LU M 01 h Rd, Wappingers Falls, NY 12590
STREET CITYrrOWN STATE ZIP
~~~R~:RT~~~ IO~O~~~N~ZJ~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME DAY YEAR 0 0 RELIGIOUS 1 0 CIVIL
~tl6E ~~gl1TJ~E TIME AND 9)( OTHER, SPECIFY ~I Jl J']111tL
by New York DDmestic
MONTH
YEAR
03:11:~ 05
02 2010
04
2010
07
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYDUTCIfE>~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
~ CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFYf()l)ChfY.~/E
NAME (PRINT)
SIGNATURE~