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165 "-' w ('I") ~ ('I") ~ ll"\ N ,....; I- ... m :> :ll c( O~ C ~u: -,LL (/) .. ~ c( 5~ z i= 0 ~ <(a::~ 0 ~ ~~ 5 ~~ a::;j ~I-'J <( a:~ ~-1 31 3 31 ~5' -=;I:: t= ffi .. ClQl lj!~ willa: ~~ ~ ~ ~ ~ lj!1ll; o z ~;j~ >- t=I ~ u.. a: ~.-.t; g;N ~:i:z W ::It:Q I-~I- ... ~~~ c( t;~~ U ::lOW ::I!~g u:: I.L i= 0 a: f/l W ' >- 'M~ u I-~ll) i~<!; STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM Timothy J. FIRST MIDDLE COUNTY . CITYfTowlll DISTRICT NUMBER REGISTER NUMBER Dutchess Wappinger 1368 165 A. FULL NAME Gardner. Jr. CURRENT SURNAME 0- N B BIRTH NAME, IF DIFFERENT C. SURNAME AFTER MARRIAGE (OPTIONAL. SEE REVERSE) D SOCIAL SECURITY NUMBER 2. RESIDENCEA. New York (STATE) C. CHECK ONE 0 CITY Xl TOWN 0 VILLAGE ~~~CIFY Eas t Fishkill D STREET ADDRESS 21 Du an Lane ZIP 12533 E. IS RESIDENCE WITHIN LIMITS OF CITY R INCORPORATED VILLAGE' 0 YES ~ NO /01 /1979 DAY YEAR 096-62-8377 B. Dutchess ,COUNTY) 3. A. AGE 21 Feb. 3B. DATE OF BIRTH MONTH 4. EMPLOYMENT A. USUAL OCCUPATION Machine Operator B. TYPE OF INDUSTRY OR BUSINESS . S toneykill Exca. 5. PLACE OF BIRTH Poughkeepsie, New York (CITY, STATE/COUNTRY IF NOT USA) 6. FATHER A. NAME Timothy J. Gardner, Sr. B. COUNTRY OF BIRTH USA 7. MOTHER A. MAIDEN NAME B. COUNTRY OF BIRTH Debra Durso USA First 8. NUMBER OF THIS MARRIAGE 9. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT DEATH 3. HOW DID LAST MARRIAGE END' 131:: DIVORCE " DATE LAST MARRIAGE ENDED? (31 0 ANNULMENT / / (2) 0 DEATH MONTH DAY YEAR D. ARE ANY FORMER SPOUSE(S) ALIVE?:: YES :: NO '0 IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION DATE OF DECREE PLACE ISSUED AGAINST WHOM (MONTH. DAY, YEAR) ICITY, STATEfCOUNTRY. IF NOT USA) SELF SPOUSE 11. A. FUUL NAME I" STATE FILE NUMBER (THIS SPACE FOR STA TE USE ONLY) I /~I,~/t)l> L 0 SUPPLEMENTAL FILE FROM THE BRIDE Rachel V. FIRST MIDDLE ~ Rhodes CURRENT SURNAME B. BIRTH NAME :MAIDEN NAMEi. IF DIFFERENT 27, TYPE OF CEREMONY o 0 RELIGIOUS o OTHER, SPECIFY C, SURNAME AFTER MARRIAGE Gardner (OPTIONAL. SEE REVERSE) 180-68-3012 D. SOCIAL SECURITY NUMBER 12. RESIDENCEA. New York B. Dutchess (STATE) (COUNTY) C. CHECK ONE 0 CITY IX TOWN 0 VILLAGE ;~CIFY East Fishkill D. STREET ADDRESS 21 Dugan Lane ZIP E. IS RESIDENCE WITHIN LIMITS OF CI>>8Jl~~WJJ,.E;v1ta~f iOIG 13. A. AGE 20 13,B. DATE OF BIRTH Oct. /20 MONTH DAY 14. EMPLOYMENT 12533 YES ~ NO /1979 YEAR A. USUAL OCCUPATION Retail B. TYPE OF INDUSTRY OR BUSINESS Filene ' s portchester, New York (CITY, STATElCOUNTRY IF NOT USA) 15. PLACE OF BIRTH 16. FATHER A. NAME Frederick Rhodes B. COUNTRY OF BIRTH USA 17. MOTHER A. MAIDEN NAME B COUNTRY OF BIRTH Wilma Mej ias USA First 18. NUMBER OF THIS MARRIAGE 19. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT DEATH B. HCW DID LAST MARRIAGE END' (3) C DIVORCE 3) = ANNULMENT 2) = CEATH C. DATE LAST MARRIAGE ENDED? / / MONTH DAY VE.'R D ARE ANY FORMER SPOUSE(S) ALIVE? eYES = NO 20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATiON DATE OF DECREE PLACE ISSUED AGAINST WHOM ,MONTH. DAY. YEAR) CITY. STATEfCOUNTRY, IF NOT USAI SELF SPOUSE 1ST 2ND 3RD 4TH I, being duly sworn, depose and say, that to the best of my as to my right to enter into the ma~state. 21. SIGNATURE OF GROOM ~ '-"' 25. B. SOLEMNIZATION PERIOD ENOS AT MIDNIGHT ON: TIME MONTH DAY YEAR MONTH DAY YEAR 2, SIGNATURE OF BRIDE ~ - U N E 23. SUBSCRIBED AND SWORN TO BEFORE ME D t T Cl rk S 11 2000 SIGNATURE OF TOWN OR CITY CLERK ~ epu y own e DATE ep t . , This license authorizes the marriage in New York ate 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. LJ If checked. this license is to be used ani for the purpose of a second or subsequent ceremony. 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS aine H. Snowden, Town Clerk DATE 9/11/00 NY 12590 0 U LJ ~ C'"' 0 ~ w U) Z W u ::i ~ { SEAL } '-v-' SIGNATURE MAILING ADDR PO Box s I CERTIFY THAT I SOLEMNIZED THE MARRIAGE OF THE PER- SONS NAMED ABOVE ON THE DATE AND AT THE TIME AND PLACE INDICAT 10 :30AM PM CIVIL 00 11 10 9 12 28, PLACE WHERE MARRIAGE OCCURRED A. C. LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) o CITY OF 0 TOWN OF rAscio