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COUNTY Dutchess
CITYfTOWN Wapringp.r
~~~:~c: 1 368
~5~~;~R 74
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
S & ~ b I't \M' t
CO ~ lP e lit ~~T SURNAME
I
STATE fiLE NUMBER
(THIS SPACE FOR STATE USE ONLY)
U1
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Cara Michelle Wood
MIDDLE CURRENT SURNAME
-1
11. A. FULL NAME
FIRST
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Wintp.rs
(OPTIONAL' SEE REVERSE).. 598
D. SOCIAL SECURITY NUMBER '\ 20-72-8
12. RESIDENCE ANY BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY..tJ TOWN 0 VILLAGE
~~~cIFYFishkill
D. STREET ADDRESe2.48 Crestwood Court
ZIP 12524
o YES~ NO
;(982
YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
O. SOCIAL SECURITY NUMBER 589- ?6-Rn~q
2 RESIDENCEA. NYSTATE) B. ~f"SS
C. CHECK ONE 0 CITY .,j[J TOWN 0 VILLAGE
~~~CIFY Fishkill
D SlREET ADDRESS ?4R C':rp.~twnnd C':ourt ZIP 12524
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES..o NO
M~"l / ~~ / ~:tl'2
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE?7 13B.DATE OF BIRTH 10 ,,08
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Student
B. TYPE OF INDUSTRY OR BUSINESS DCC
15. PLACE OF BIRTHBrooklyn, New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAMERussel1 Charles Wood
'B. COUNTRY OF BIRTt-U S A
3B. DATE OF BIRTH
3. A. AGE 37
4. EMPLOYMENT
A. USUAL OCCUPATION Law Enforcement
B. TYPE OF INDUSTRY OR BUSINESS l €lw Fnfnrr.p.mp.nt
5. PLACE OF BIRTH Holllwood Flnrirl~
(CITY, TATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Richard Winters
B. COUN1RY OF BIRTH II !=\ A
7. M01HER
A. MAIDEN NAME Cnncpttin~ M~rip P~~r.lll1i
B. COUNTRY OF BIR1H I I ~ A
8. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
17. MOTHER
A MAIDEN NAME Christine Theresa Prestipino
B. COUNTRY OF BIRTt-U S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEA lH
o
DEATH
o
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B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? nR / ?n / ?003 c. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR MONTH DA Y ~ YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
,.
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINSl WHOM DAlE OF DECREE PLACE ISSUED AGAINST WHOM
(MON1H, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 08/?n/?nn3 PDllghkAP.psip., Ny D!!'f 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I duly swear/affirm, depose andjY, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the m nage state. /1 ~
21. SIGNATURE OF GROOM. ~ W, ~ 22. SIGNATURE OF BRIDE. l. .~
USE CU AME USE CURRENT NAME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNA lURE OF TOWN OR CITY CLERK.
This license authorizes the marriage in New Yo tate of the bride and groom named above by any person authorized by New York Domestic
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
1
DATE
06/30/2010
r-^--
{ SEAL}
'-v-'
liME
MONTH
YEAR
MONTH
YEAR
NAME (PRINT)
DATE 06/30/2010
in ers Falls NY 12590
ITYfT WN STATE ZIP
26. SOlEMNIZAlION OCCURRED 27. TYPE OF CEREMONY
TIME MO. AY YEAR 0 0 RELIGIOUS
9 0 OlHER, SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~TOWN OF 0 VilLAGE OF
SPECIFY W ~~e r
AM
01 :43 PM 07
01
2010
08
29 2010
STREET
I CERTIFY THAI I SOLEMNIZED
lHE MARRIAGE OF lHE PER,
SONS NAMED ABOVE ON THE
DATE AND AT lHE liME AND
PLACE INDICATED.
1~VIL
29. OFFICIANl
NAME (PRINT)
E
30. WI1NESS 10 CEREMONY
~ ) \ Ak [)
NAME (PRIN1)
SIGNA1URE.
DOH.98 (09/2009)
NAME (PRINT)
SIGNATURE.