157
L
.....
ro
o
lJ"\
N
......
~ to-
~ :;
ilj >< ct
gZwe
~ ~ ~
(/) C -' ...
z 0;:;; ct
Q u ~
~ tll 0
fEQ)~
"'cOt:
a u
w
a:
w"O
~ tll
ir 0
~~
:tJ
"0
o
o
~:3
~
a:
j ill
w~
a: U
~ 0 ffi
;=....JeD
g5 ~
w . z
gsz~
o ..
c(:.Jtu
~o ~
8"" try
a.
'"
z-z
!5=Q
~;;~
~~~
...-:zjZ
cn....;~
:lUW
~~~
2:5...
10
'(/)
.>
. 0(
~o
o~;
z::;_
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New Yo r k
,STATE) V,
C. CHECK ONE C CITY ei TOWN w
~~~CIFY Fishkill
o STREET ADDRESS 60E N. Lockey Woods gdzlP 12508
Beacon v,
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES QJ NO
3. A. AGE 26 3B. DATE OF BIRTH May / 25 /1974
MONTH DAY YEAR
COUNTY Dutchess
~~OWN Wappinger
~~~~~ 1368
~5~~J~R 157
1. A. FULL NAME
a.
N
8. BIRTH NAME. IF DIFFERENT
4. EMPLOYMENT
w
~
..
~
(/)
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
James Edward
FIRST MIDDLE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Julie Ann
-1
Maupin
CURRENT SURNAME
Call
CURRENT SURNAME
11. Pc FULL NAME
FIRST
MIDDLE
125-66-8657
B Dutchess
(COUNTY)
VILLAGE
8. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York
(STATE)
c. CHECK ONE 0 CITY Xl TOWN 0
~~~CIFY Fishkill
D. STREET ADDRESS 60E N. Lockey Woods Rd 'ZIP 12508
Beacon
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
13. A. AGE 22 13.B. DATE OF BIRTH May /05
MONTH DAY
CALL
074-72-0133
Dutchess
(COUNTY)
VilLAGE
B.
YES Xi NO
/1978
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Production Engineer
B. TYPE OF INDUSTRY OR BUSINESS IBM Corp.
5. PLACEOFBIRTH Plattekill, New York
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7, MOTHER
A, MAIDEN NAME
B. COUNTRY OF BIRTH
B, NUMBER OF THIS MARRIAGE
A. USUAL OCCUPATION Pharmacy Associate
B. TYPE OF INDUSTRY OR BUSINESS Walmart
15. PLACE OF BIRTH Portches ter , New York
(CITY. STATE/COUNTRY IF NOT USA)
John F. Call
USA
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
lB. NUMBER OF THIS MARRIAGE
A. MacDonald
Gregory A. Maupin
USA
Carol Heck
USA
First
Patricia
USA
First
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
DEATH
B. HOW 010 LAST MARRIAGE END? (31 = DIVORCE
C. DATE LAST MARRIAGE ENDED?
(31 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(31 0 ANNULMENT
/ /
(21 = DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES [] NO
10. IF PREVIOUSLY DIVORCED OR ANNUlED. PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEARI (CITY, STATE COUNTRY. IF NOT USA) SELF SPOUSE
1 ST 0 C 1 ST
2ND 0 C 2ND -'
3RD 0 C 3RD "
4TH 0 C 4TH :::l
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 marriage state. / 9 . J I ~ (2 r-IJt/ '
21. { 22 SiGNATURE OF BRIDE ~ _!j~ _' '-j ri'(J/ / {)lfi-J
USE C RRENT NAME ~
23. ~ Deputy Town Clerk DATE Sept. 6, 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.
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
Elai e H. Snowden Town Clerk
DATE 9/6/00
Wappingers Falls, NY 12590
CITYITOWN STATE
27. TYPE 0 EREMONY
w
en
z
w
o
::i
.-'-.
{ SEAL }
'-v-I
NAME (PRIN
SIGNATURE
MAILING ADDR
PO Box
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ASOVE ON TH
DATE AND AT THE TIME 0
PLACE INDICATED.
/7
29. OFFICIANT ;/ / 't
NAME (PRINT) ,
25. 8. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
ZIP
AM
2: 45 PM
00
9
7
00
11
5
10 CIVil
2B. PLACE WHERE MARRIAGE OCCURRED.f) J il
A, STATE NEW YORK B. COUNTY ~
C. LOCATION OF CEREMONY
(CHECK ONE AN~ECIFY)
o CITY OF '~;f1 Lj V"ro; r;
SPECIFY <;::: I/~
SIGNATURE~