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rOUNTY
'~ITOVii<l
DISTRICT
NUMBER
REGISTER
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Aaron A. Fairfield
FIRST MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
nl11"C'npQq
W::Ippingpr
1368
182
~
1 A. FULL NAME
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Jenna K.
FIRST MIDDLE
Kniffin
CURRENT SURNAME
11. A. FULL NAME
B BIRTH NAME. IF DIFFERENT
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Fairfield
(OPTIONAL 0 SEE REVERSE) 097 -64-6 259
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) ,COUNTYI
C. CHECK ONE 0 CITY ~ TOWN = VILLAGE
~~~CIFY Hyde Park
D. STREETADDRESS 4 1'R r k 1'1 R C' e ZIP 12 518
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? LJ YES []I: NO
13.A AGE ?7 13.8. DATE OF BIRTH neC'. /Og /ig72
MONTH DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 202 -62 - 2 6 9 2
D SOCIAL SECURITY NUMBER
New York
(STATEI
= CITY ~ TOWN
Hyde Park
D STREET ADDRESS 4 Park Place
2. RESIDENCE A
B. Dutchess
(COUNTY)
VILLAGE
C CHECK ONE
AND
SPECIFY
ZIP 12538
YES:lt '<0
/ 197
YEAR
14. EMPLOYMENT
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A AGE 21 38. DATE OF BIRTH Mav / 07
'MONTH DAY
A. USUAL OCCUPATION Hember Service Supervisor
B. TYPE OF INDUSTRY OR BUSINESS HVFCU
15, PLACE OF BIRTH poughkeepsie ,New York
(CITY, STAT8COUNTRY IF NOT USA)
16, FATHER
A. NAME Lawrence Charles Kniffin
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Nancy Jane Kniffin
B. COUNTRY OF BIRTH USA
4. EMPLOYMENT
UJ
...
'"
~
A. USUAL OCCUPATION Chef
B. TYPE OF INDUSTRY OR BUSINESS Armadillo Resturant
5. PLACEOFBIRTH Stroudsburg, Pennsylvania
ICITY, STATE COUNTRY IF NOT USA)
6. FATHER
A. NAME
Frank Aaron Fairfield
USA
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B COUNTRY OF BIRTH
Deborah Hagerty
USA
First
First
16, NUMBER OF THIS MARRIAGE
8. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
DEATH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
DEATt-'
B. HOW DID LAST MARRIAGE END? 3\ = DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULME~T
/ /
(21 = DE~7H
B. HOW DID LAST MARRIAGE END? (31:= DIVORCE
C. DATE LAST MARRIAGE ENDED?
31 = ANNULMENT
/ /
(2) = DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE,Si ALIVE? = YES := NO
10. IF PREVIOUSLY DIVORCED OR ANNUlED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED ~GAINST wt-'c\t
{MONTH. DAY, YE;ARI (CITY. STATE COUNTRY, IF NOT USAI SELF SPOUSE
MONTH DAY YEAR
o ARE ANY FORMER SPOUSE(S) ALIVE? = YES = 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
()
::i
1ST 1ST []
2ND 2ND ~
3RD 3RD 0
4TH 4TH [] c..:
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 riage state, .--r.- ~ r . . J
21. SIGNATURE OF GROOM ~ ~ 22. SIGNATURE OF BRIDE ~ ~~~'\U'i.J1\.; ,), ')""--.../
URRENT N (- j JSE CURRENT NAME \ i'-J
23 ., U' e ut ClerK DATE sept. 25,2000
This license authorizes the marriage in New York State 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.
= 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)9 Elal.ne H. Snowden, Town Clerk
{SEAL SIGNATURE ~(:--0uu h-\ S,~'V\,.,d;1 , DATE 9/25100 TIME MONTH DAY YEAR MONTH DAY
MAILING ADDRESS AM
~ P.O. Box 324 Wappin~ers Falls NY 12590 1:35PM 09 26 00 11 24
TREET CITYiTOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY YE.~R 0 C REL:GIOUS
DATE AND AT THE TIME AND . J'C AM /'0 Oct ""-.
PLACE INDICATED . PM I......' 9 [] OTHER. SPECIFY
l.hk>.vf,.v.:. t: ~Utn, cc ""c..o
LbtZ ~ ~'Tj:,
Rd.
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
YEAR
00
28. PLACe "HERE MARRIAGE OCCURRED
~IVIL
A. STATE NEW YORK B. COUNTY pi.(:jt~e~S
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WN OF 0 VilLAGE OF
SPECIFY /J.r'" Pct.l-k..
29. OFFICIANT
NAME (PRINT)
::~ f;wV~~,hf!1<
Cf""i:,. ;vev 6'..~ 1~:f3c?
STATE ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) 11/ r.. H G '-c
o 1'"
~
I';r~
ST EET
30 WITNESS TO CEREMONY
NAME (PRINT) C:;;;~If~~{ 67~,,!fh
SIGNATURE~ ~.ef ~~
;:JJ/6'kt'T
SIGNATURE ~