152
4
I1l
....
"
:)
:T.
.~~
I1l
+..I
Ul
::l
00
::l
<w
>-
..~
Ql'"
:>
....
H
o
iz ~ !::
~Ql >
WH <(
~~ C
8QlgU:
ill~ '" u..
z I1l ~ <(
Q....:l ~
~ 0
a:+..It:
~Ul~
a Ql OJ
ll!:3
w
'-'0'1
:$0
n::~
t""l
,..,;
s< 0
'= Ul
Ii: ~
w.~
U,o
ll! 0
~P::ffi
;: <Xl
'" 11l:lE
t3.~ ~
a::>~
g~"
".~>-
~cn~
(J >-
~ 0 Cf.l
'"
:oJ
ZIZ
~!::Q W
>- ;: >- .-
~~~ ..,
>-wz -
~d~ 0
~'fg u:
hi ~
~ )g! W
.....w ~ 0
l!!~",
o~z
z...._
COUNTY
~ITOWN
DISTRICT
NUMBER
REGIiTER
NUMBER
ST A TEOF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Sean Alan
FIRST MIDDLE
I
STATE FILE NUIIBER
(THIS SPACE FOR STATE USE ONt y)
I
r.
J
Dutchess
Wappinger
1368
152
-y/ql~~
L 0 SUPPLEMENTAL FILE
-.J
FROM THE BRIDE
Kochendorfer
CURRENT SURNAME
amyrae
FIRST
1. A. FUll NAME
Barbaras
CURRENT SURNAME
11. A. FULL NAME
MIDDLE
B. BIRTH NAME. IF DIFFERENT
B. BIRTH NAME I MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B Dutchess
(STATE) . ,COUNTY)
C. CHECK ONE 0 CITY 0 TOWN Xi VILLAGE
~~~CIFY Wappingers Falls
!) STREETAODRESS 40 Clapp Avenue ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? Xi YES 0 NO
13.B. DATE OF BIRTH April /25 /1976
MONTH DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER
2. RESIDENCE A. Geor~ia B.
(STATE) (COUNTY)
o CITY Xi TOWN '-J VILLAGE
Si~nal BN ROA Fort Gordon
o STREET ADDRESS B Company 442d ZIP 30905
Barbaras
533-78-1518
525-63-7948
C. CHECK ONE
AND
SPECIFY
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES Xi NO
3 A. AGE 21 3B.DATEOFBIRTH Sept. / 8 /1978
MONTH DAY YEAR
13. A. AGE
24
14. EMPLOYMENT
4. EMPLOYMENT
A. USUAL OCCUPATION Unemployed
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Sunnyside, Washington
(CITY. STATE/COUNTRY IF NOT USA)
A. USUAL OCCUPATION Mili tary
B. TYPE OF INDUSTRY OR BUSINESS U. S. Army
5. PLACE OF BIRTH Alamogordo. New Mexico
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
1 B. NtJMBER CF THIS MARRIAGE
Nancie Thompson
USA
First
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7 MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Richard Barbaras
USA
Glen Kochendorfer
USA
Linda Robinson
USA
First
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
19. PREVIOUS MARRIAGES
A. NUMBE? OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVCRCE CIVIL ANNULMENT
DEATH
DEATH
(2) 0 DEATH
(21 = ilEATH
B. HOW DID LAST MARRIAGE END? 31 = DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? / /
MONTIi DAY YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? = YES 'J NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE 'LACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) ,CITY. STATE COUNTRY. IF NOT USA) SELF SPOUSE
8. HOW DiD ;.AST MARRIAGE END? (3) 0 DIVDRCE 31 ::: ANNULMENT
c DATE _~ST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. ARE ~NY "ORMER SPOUSE(S) ALIVE?::: YES = NO
20. iF PREVICUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DA TEeF JECREE PLACE ISSUED ~GAINST WHOM
MONT;., JAY. YEAR) (CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
W
en
z
W
o
::l
1ST LJ 1ST
2ND 'J 2ND
3RD CJ 3RD
~ 0 ~ 'J
I. being duly sworn. depose and say. that to the best of my knowledge and belief that the informanon I provided is true and that I declare that no legal impediment eXists
as to my right to enter into the ma 'age state.
21. SIGNATURE OF GROOM ~ rs 22. SIGNATURE OF BRIDE ~ t111V\ LW~ ~c;j1rv'V1-4_2~/:
""\i u- USE CURRENT NAME ~
23. ~ Deputy Town Clerk DATE Sept. 1, :WOO
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.
:J If checked. this license is to be used only for the purpose of a second or subs uent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOUEMNIZATION PERIOD BEGINS 25. B. ~MA~~IB~~f~~O
{ } NAME (PRINn ~aine H. ~owden: Town Clerk TIME MONTH DAY YEAR MONTH DAY
SEAL SIGNATURE~_~lIU ~ ~~- DATE 9/1/00
MAILING ADDRE~ 9 : 30 AM
'-v-' PO Box ]24, Wa in ers Falls, NY 12590 PM 9 2 00
REE ITY NAZI
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
~~~SM~:~g~B~v~H;N Pi.fe TIM DAY Y A 0 ~ELlGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER. SPECIFY
YEAR
10
31
00
28. PLACE WHERE MARRIAGE OCCURRED
CIVIL
~&lf
A. STATE NEW YORK B. COUNTY
29. OFFICIANT
NAME (PRINT)
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF