No preview available
053 + w ~ ~ N U") N T""" ... ~>- :> wZ c( ~ e 5=~L&. ~~~L&. ~~~c( 0'-3 ~u..g 1Il"'O~ ffio::'"' ~ .... ~ if ~ ... o ~ '"' ii: ~ w '"' w a: w ~ III III w a: o o <0( ~ o w "- III w en z -w o ::i + ~~z ~~~ W a:"~ ~ l;;~~ 0 ::>ow ~<.!l5 u:: tz~1Il - ~~t5 t: [EO(/) W ~~~ 0 ~ffi~ ~3~ STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM Michael Aaron McKeehan MIDDLE CURRENT SURNAME COUNTY Dutchess CITYfTOWN Wappinger ~~~:~:1368 ~~~I:J~R 53 1. A. FULL NAME FIRST "- N B. BIRTH NAME, IF DIFFERENT C. SURNAME AFTER MARRIAGE (OPTIONAL - SEE REVERSE>1 00-76-0357 D. SOCIAL SECURITY NUMBER 2. RESIDENCE A. NY B. Dutchess (ST ATE) (COUNTY) C. CHECK ONE 0 CITYo{] TOWN 0 VILLAGE ~~~CIFY Fishkill o STREET ADDRESS 111 Cooper Rd ZIP 12524 E. IS RESIDENCE WllHlN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES ""'0 NO 3. A. AGE 25 3B. DATE OF BIRTH 10 / 17 /1984 MONTH DAY YEAR 4. EMPLOYMENT A. USUAL OCCUPATION Programmer B. TYPE OF INDUSTRY OR BUSINESS Utility 5. PLACE OF BIRTH Beacon, NY (CITY, STATE / COUNTRY IF NOT USA) 6. FATHER A. NAME Michael Milton McKeehan B. COUNTRY OF BIRTH USA 7. MOTHER A. MAIDEN NAME Carol Ann Lehning B. COUNTRY OF BIRTH USA 8. NUMBER OF THIS MARF,\IAGE 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) 0 DIVORCE C. DATE LAST MARRIAGE ENDED? (3) 0 ANNULMENT / / (2) 0 DEATH 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) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE a:' w "' ~ ::> z o z <0( tii w ~ STREET I CERTIFY THAT I SOLEMNIZED THE MARRIAGE OF THE PER- SONS NAMED ABOVE ON THE DATE AND AT THE TIME AND PLACE INDICATED. Orl~11 NAME (PRINl) iJ t KtJh/ -- r>1,.."IATllnr...... r.l'1 fV'j". ~ I STATE FILE NUMBER (THIS SPACE FOR STATE USE ONL Y) "I L 0 SUPPLEMENTAL FILE FROM THE BRIDE Michelle Fornabaio ~ 11. A. FULL NAME FIRST MIDDLE CURRENT SURNAME B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT C. SURNAME AFTER MARRIAGEMcKeehan (OPTIONAL - SEE REVERSE~ 1 0-76-7619 D. SOCIAL SECURITY NUMBER 12. RESIDENCE ANY Boutchess (STATE).L.. (COUNTY) C. CHECK QI'iE. 0 CITY -U TOWN 0 VILLAGE ~~~CIFYvvappmger hU I op U Hili KO '12590 D. STREET ADDRESS- ZIP "'" E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES f8 NO 13. A. AGE22 3B. DATE OF BIRTH 11 Y1 .l9 7 MONTH DAY YEAR 14. EMPLOYMENT A. USUAL OCCUPATIONManager B. TYPE OF INDV~TRY OR BUSI~~~Ketall 15. PLACEOFBIRTHyonl<ers, NY (CITY, STATE / COUNTRY IF NOT USA) 16, FATHER A. NAMEJoseph Anthony Fornabaio 'B. COUNTRY OF BIRTJ-J S A 17. MOTHER C h' AT" A. MAIDEN NAME ynt la nn aCjl B. COUNTRY OF B;:-J-J S A 1 18. NUMBER OF THIS MARRIAGE 19. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DffORCE CIVIL A~ULMENT DtfTH (3) 0 ANNULMENT (2) 0 DEAlH / / ..- YEAR B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE 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) (CITY/COUNTY, STATE/COUNTRY,IF NOT USA) SELF SPOUSE YEAR 10 CIVIL 28. PLACE WHERE MARRIAGE OCCURRED ') ~ A. STATE NEW YORK B. COU~~' C. LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) o CITYOF~N~ WL SPECIFY P~'Vfi!.A- ZIP 31, WITNESS TO CEREMONY :~~~~:::~~~ ~~h~"b