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1. A. FUU NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
William M.
I STATE ALE NUMBER ~
(THIS SPACE FOR STATE USE ONL Y)
)f/IO/11/01)
Lo SUPPLEMENTAL FILE ~
.
COUNTY < Dutchess
. ClllY/TollN Wappinger
~~~~~~T 116 8
~5~~J~R 184
FROM THE BRIDE
Sheila M.
FIRST MIDDLE
Conniff
Lenahan
CURRENT SURNAME
1 L A. FUll NAME
FIRST
MIDDLE
CURRENT SURNAME
B BIRTH NAME, iF DIFFERENT
B. BIRTH NAME [MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Conniff
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER 096 -4 4 -15 5 4
12. RESIDENCEA. New York B Westchester
(STAW) . (COUNTY)
C. CHECK ONE ~ CITY D TOWN C VilLAGE
~~~CIFY Peekskill
o STREET ADDRESS 150 Overlook Ave. 7K ZIP 10566
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 207-52-2194
2 RESiDENCE A New York B. Dutchess
(STATE) (COUNTY)
D CITY ~ TOWN C VilLAGE
Wappinger
D. STREET ADDRESS 43D Scarborough Lane
C. CHECK ONE
AND
SPECIFY
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VilLAGE?
3. A. AGE 37 38. DATE OF BIRTH OC t . /
ZIP 12590
DYES~NO
25 /1962
YEAR
13. A. AGE
33
MONTH
DAY
E. is RESIDENCE WITHIN LIMITS OF CITY OR INCORPCRA TED VilLAGE? ~ YES D NO
13.B. DATE OF BIRTH Dec. / 02 /1966
MONTH DAY YEAR
4. EMPLOYMENT
14. EMPLOYMENT
A. USUAL OCCUPATION Sales Representative
B. TYPE OF INDUSTRY OR BUSINESS Premier Athletic Club
15. PLACE OF BIRTH Mahopac , New York
(CITY. STATEiCOUNTRY IF NOT USA)
A. USUAL OCCUPATION Engineer
B. TYPE OF INDUSTRY OR BUSINESS IBM Corp.
5. PLACE OF BIRTH Scranton, Pennsylvania
(CITY, STATEiCOUNTRY IF NOT USA)
16. FATHER
A. NAME
8. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Harte
6. FATHER
James Vincent Lenahan
USA
A. NAME William P. Conniff
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Geraldine M. Craig
B. COUNTRY OF BIRTH USA
Joan Marie
USA
First
B. NUMBER OF THIS MARRIAGE
First
18. NUMBER OF THIS MARRIAGE
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
DEATH
DEATH
B. HOW DID LAST MARRIAGE END? (3) L! DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) D DEATH
B. HOW 010 LAST MARRIAGE END? 13) 0 DIVORCE 3\ C ANNULMENT
C. DATE LAST MARRIAGE ENDED? / /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNUlED. PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY, STATE!COUNTRY. IF NOT USA) SELF SPOUSE
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? C YES C NO
20. IF PREVIOUSLY DIVORCED OR ANNUlED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE!COUNTRY. IF NOT USA) SELF SPOUSE
w
en
z
w
o
::::i
1 ST 0 L 1 ST D D
2ND D 2ND D D
3RD [] 3RD D D
4TH D L 4TH [] D
I. being duly sworn, depose and say, 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 marri ge te. {) " ~.
21. SIGNATURE OF GROOM ~. I '. 22. SIGNATURE OF BRIDE ~ ~~-
. . J ' USE CURRENT NAME
~ Deputy Town Clerk DATESept. 26, 2000
This license authorizes the marriage in New York Stat 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.
D 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)~ne H.~owde~ Town Clerk
{SEAL SIGNATURE ~E:111UlC' Q~.h~ ~( _ DATE 9/26/00 TIME MONTH DAY YEAR MONTH DAY
MAILIt1ClAQPRESS AM
~ ~U tlox 324, Wappingers Falls, NY 12590 1..45 PM 9 27 00 11 25
STREET CITYfTOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER. . ....J
SONS NAMED ABOVE ON THE TIME MO. DAY Y R 0 Ilo!f RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 0 0 9 D OTHER. SPECIFY
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
YEAR
00
28. PLACE WHERE MARRIAGE OCCURRED
1 D CIVIL
A. STATE NEW YORK B COUNTY lJ. ()I/C'5. -rel<-
C.
29. OFFICIANT
NAME IPRINT)
eRe)
~~
TITLE
NAME (PRINT)
SIGNATURE ~