193
~
01
>-
'"
at:;
0'\
LI"\
N
......
... I-
~>< >-
iJlZ
~ <(
'3UlwC
5~~U:
ai~gu..
~~z <(
... ~
~ Ul g
S; ,.. ~
a ill u
UJ
0:: ~
~.,-!
'"
~ill
~ >
a:-,-1
;= H
~~
(.)
:1! ill
'l! ~a:
-.,-!w
~ OJ
iJl ::;
",~::J
ii!<~
o z
~ ~~
,..Lr'l~
I:!: Me:
i.) I-
UJ "'
a-
iJl
ZIZ
~~~ W
li!~~ ~
... UJ z .....
~0~ 0
'Sl i!
t=
IX:
W
()
,....
,0
~~
w~~
...~'"
~~;;
STATE OF NEW YORK I STATE FILE NUMBER I
Dutchess (THIS SPACE FOR STA TE USE ONL Yi
COUNTY DEPARTMENT OF HEALTH
X2.'iTY/TO~N Wappinger
DISTRICT 1368 AFFIDA VIT, LICENSE and
NUMBER
REGISTER 193 CERTIFICATE OF
NUMBER
MARRIAGE Lo SUPPLEMENTAL FILE ~
FROM THE GROOM FROM THE BRIDE
A FULL NAME Eric S. Parker 11. A. FULL NAME Sandra L. Ellison
FIRST MIDDLE CURRENT SURNAME FIRST MIDDLE CURRENT SURNAME
a-
N
B BIRTH NAME ,MAIDEN NAMEI, IF DIFFERENT
B. BIRTH NAME, IF DIFFERENT
Ellison-Parker
066-62-9313
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New Yo r k
ISTATE! v
C. CHECK ONE = CITY ~ TOWN
~~~CIFY Wappinger
o STREET ADDRESS 35B Alpine Drive
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
SOCIAL SECURITY NUMBER
New York
(STATEI
C CHECK ONE C CITY 00 TOWN
AND W'
SPECIFY app~nger
o STREET ADDRESS 35B Alpine Drive
ZIP 12590
090-68-0099
Dutchess
(COUNTY)
VILLAGE
12. RESIDENCE A.
Dutchess
COUNTY)
VILLAGE
B.
12590
ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE 31 3B. DATE OF BIRTH April / 23
MONTH DAY
YES X ~o
/1969
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES x: NO
13.A. AGE 31 13.B.DATEOFBIRTH Aug. / 13 /1969
MeNTH DAY YEAR
4. EMPLOYMENT
14. EMPLOYMENT
A. USUAL OCCUPATION Student
B. TYPE OF INDUSTRY OR BUSINESS MTl
5. PLACE OF BIRTH Gloversville. New York
,CITY. STATE COUNTRY IF NOT USAI
A. USUAL OCCUPATION Secre tary
B. TYPE OF INDUSTRY OR BUSINESS Vassar College
15. PLACE OF BIRTH White Plains , New York
(CITY, STATEiCOUNTRY IF NOT USA'
16. FATHER
A. NAME James Ellison
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Diane Maratto
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE Second
6. FATHER
A. ~ME Albert Parker
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME
Bonna Sroufe
B COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE Firs t
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
DEATH
DEATH
B. HOW DID LAST MARRIAGE END? 13) = DIVORCE (3) 0 ANNULMENT ,21 = DE~~H
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
o ARE ANY FORMER SPOUSE,S) ALIVE? = YES = NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMAT eN
DATE OF DECREE PLACE iSSUED AGAINST WHCM
(MONTH. DAY, YEAR) rCITY. STATE- COUNTRY. IF NOT USA) SELF SPOUSE
B. HOW DID LAST MARRiAGE END? 131 X DlveRCE 3' = ANNULMENT (21 '--- DEATH
C. DATE LAST MARRIAGE ENDED? Nov. /21 / 1995
MONTf-; JAY YEAR
D. ARE ANY FORMER SPOUSEiS) ALIVE? X: YES = NO
20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE 7HE FOLLOWING INFORMATION
DATE OF DECREE PLACE ;SSi.:ED AGAINST WHOM
,MONTH. DAY, YEAR) rCITY. STATE-COUNTRY 'F NOT i.:SA\ SELF SPOUSE
1ST 11/21/95 Poughkeepsie, NY = X::
2ND ~
3RD
1ST
2ND
3RD
21. SIGNATURE OF GROOM ~
4TH
Y knowleoge and belle! that the information I provided is true and that I declare that no legal IfTlpediment eXists
22. SIGNATURE OF BRIDE ~ ~I./L-- D t~ ~
. USE CURRENT~AME ~
Deputy Town Clerk DATE Oct. 2, 2000
w
en
z
w
()
:;j
23. SUBSCRIBED AND SWORN TO BEFORE ME
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.
= 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 IPRINT) ~ Ela~ne H. Snowden, Town Clerk
{SEAL} SIGNA~URE~?--Qfu....u \l~V\,\vi;I. DATE 10/2/00
M4UJNG.C\DDRE~4. 12590 10'35AM
'-.t-I .t'u nox .:J,L , WappJ.ngers Falls, NY .
STREET CITYITOWN STATE ZIP PM
~~~~~~Ri~~~ 10~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27 TYPE OF CEREMONY /
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR REL.GIOUS 1 YCIVIL
DATE AND AT THE TIME AND
PLACE INDICATED.
12
01
00
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIONIGHT ON:
MONTH
DAY
YEAR
TIME
MONTH
DAY
YEAR
3
00
10
OTHER. SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY ~F. '1.. .TOWN OF LJ VILLAGE OF
SPECIFY~r~~
~
SIGNATURE ~