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COUNTY
JOG"rrOWN
DIS~'CT
NUMBER
REGISTER
NUMBER
Dutehes~
Wappinger
1368
161
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
N . Ohrvall
""DDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL V)
I
L 0 SUPPLEMENTAL FILE
~
FROM THE BRIDE
M.
MIDDLE
Mc Vei~h
CURRENT SURNAME
1 A. FULL NAME
Brian
FIRST
11 A. FULL NAME
Kristen
FIRST
il.
N
8. BIRTH NAME ,MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Ohrvall
,OPTIONAL. SEE REVERSE)
SOCIAL SECURITY NUMBER 119 - 7 4-12 7 7
12 RESIOENCEA New York B Dutchess
,STATE) ,COUNTY)
CHECK ONE 0 CITY~ TOWN C VILLAGE
~~~CIFY Fishkill
J. STREET ADDRESS 35 Alice Lane ZIP 12524
8 BIRTH NAME, IF DIFFERENT
C, SURNAME AFTER MARRIAGE
IOPTIONAL . SEE REVERSE)
D SOCIAL SECURITY NUMBER
2 RESIDENCE A New York
(STATE)
= CITY ~ TOWN =
Fishkill
D STREET ADDRESS 35 Alice Lane
B
C, CHECK ONE
AND
SPECIFY
ZIP 12524
OYES~NO
/1978
YEAR
14, EMPLOYMENT
_ :S RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE'
13.,1., AGE 19 13,8. DATE OF BIRTH July / 13
MONTH DAY
YES ~ NO
/1981
YEAR
E, IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE?
3 A, AGE 22 3B,DATEOFBIRTH Jan. A5
MONTH OA Y
4, EMPLOYMENT
A. USUAL OCCUPATION Homemaker
8. TYPE OF INDUSTRY OR BUSINESS unemployed
15, PLACE OF BIRTH Mt. Riseo ~ New York
(CITY, STATEiCOUNTRY IF NOT USA)
16. FATHER
A. NAME Patrick J. McVeigh
B, COUNTRY OF BIRTH USA
17. MOTHER
A, MAIDEN NAME Jane M. Young
s, COUNTRY OF BIRTH USA
18, ~L:MBER OF THIS MARRIAGE Firs t
19 PREVIOUS MARRIAGES
A, ~UMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
UJ
>-
<(
>-
.fl
A. USUAL OCCUPATION Cons t ruc t ion Management
B. TYPE OF INDUSTRY OR BUSINESS GBH Macomber
5, PLAOEOFBIRTH PouO'hkeen~ie, New York
<.CITY. STA'iB'COUNTRYIF NOT USA)
6. FATHER
A. NAME John R. Ohrvall
B. OOUNTRY OF BIRTH USA
7, MOTHER
A. MAIDEN NAME Adelaide L. Consaga
8. 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
DEATH
8. HOW DID LAST MARRIAGE END? ,3' = :IVCRCE 3) :J ANNULMENT (21 'C DE~TH
C DATE ~ST MARRIAGE ENDED? / /
MCNTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) AlIVE7 = YES = 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
B. "OW DID LAST MARRIAGE END' (31 = DIVORCE
v. JATE LAST MARRIAGE ENDED?
3) = ANNULMENT
/ /
2' = oEAT~
MONTH DAY YEAR
" ~RE ANY FORMER SPOUSE(S) ALIVE? = YES = NO
20, iF ""lEVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING iNFORMATION
JA TE OF DECREE PLACE ISSUED AGAINST WHOM
MONTH, DAY. YEAR) ICITY, STATE-COUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
21
,2000
by New York Domestic
w
(J)
Z
w
o
::i
23. SUBSCRIBED AND SWORN T 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 persDn authorized
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
{ } NAME <PRIN~ Elapl;e H. Snowden, Town Clerk TIME MONTH DAY YEAR
SEAL SIGNATURE ~ ~~t.u,,~~ DATE 9/8/00
MAILING ADDRESS AM
'-.t-l P.O. Box 324 Wappingers Falls. NY 12590 2: 45 PM 09
STREET CITY,TOWN STATE ZIP
~~~R~~~Ri~~~ 'O~O~~~N~ZEE~ 26 SOLEMNIZATION OCOURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 ~ELIGIOUS
DATE AND AT THE TIME AND '. ()C AM
PLACE INDICATED. ,
11
07
00
25. 8, SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON
MONTH
DAY
YEAR
09
00
28, PLACE WHERE MARRIAGE OCCURRED
1 = C:VIL
A. STATE NEW YORK B. COUNTY i)~, f-c./t.:.J :
00 90 OTHER, SPECIFY
C LOCATION OF OEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF lI~oWN OF = VILLAGE OF
F;sht,/!
C A ;-r/~ '-/e P/1 ICS-
/~ _1/ 7 -clt/
.
,IVy /2.J-Z
STATE
SPECIFY
t< 0 (3 f.ltl /<::, I/..JIL-J ON
C i'
SIGNATURE ~ (/ c ~/~--I ;C ~ ..t_
MAILING ADDR~ ( .
03 a t ""- J I- -, J 4 ,{, /1
S REET CITY TOWN
30, WITNESS TO CEREMONY
29. OFFICIANT
NAME (PRINT)
TITLE
DATE
NAME (PRINT)
SIGNATURE ~
31.
I1CY