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1. A. FULL NAME
5T A TE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
John S.
Cameron
CURRENT SURNAME
Talbot
Cameron-Thorne
132-42-9415
Dutchess
(COUNTY)
VILLAGE
COUNTY Dutchess
~fTOWN Wappin~er
~~~~T 1368
~5~~J~R 149
I STATE FILE NUMBER I
(THIS SPACE FOR STATE USE ONLY)
"v/ ~ 11).11 I oD
Lo SUPPLEMENTAL FILE .-J
FROM THE BRIDE
M.
Thorne
Ann
FIRST
11. A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
MIDDLE
"-
N
B. BIRTH NAME. IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE
,OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A New York
(STATE)
o CITY ~ TOWN
Wappinger
o STREET ADDRESS 1597 Rte. 376
ZIP 12590
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER
2. RESIDENCE A. New Yo r k
,STATE,
= CITY IX TOWN 0
Wappinger
D. STREET ADDRESS 1597 Rte. 376
C. CHECK ONE
AND
SPECIFY
122-38-9394
Dutchess
(COUNTY)
VILLAGE
C. CHECK ONE
AND
SPECIFY
B.
B.
ZIP 12590
DYEs:lt NO
16 /1949
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? '-'
13. A. AGE 51 13.B. DATE OF BIRTH March / 27
MONTH DAY
YES X: NO
/1949
YEAR
E. IS RESIDENCE WITHiN liMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE 51 3B. DATE OF BIRTH Feb. /
MONTH
DAY
4. EMPLOYMENT
14. EMPLOYMENT
A. USUAL OCCUPATION Auto Mechanic
B. TYPE OF INDUSTRY OR BUSINESS Poughkeepsie Ford
5. PLACE OF BIRTH Poughkeepsie, New York
,CITY. ST A TElCOUNTRY IF NOT USA)
A. USUAL OCCUPATION Food Service Worker
B. TYPE OF INDUSTRY OR BUSINESS Eurest Dining Services
15. PLACE OF BIRTH Brooklyn, New York
(CITY. STATElCOUNTRY IF NOT USA)
6. FATHER
A. NAME
8. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
16. FATHER
A. NAME
8. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Oakleigh Thorne
USA
James Talbot
USA
Vera Ward
USA
Third
Mabel Warren
USA
Third
8. NUMBER OF THIS MARRIAGE
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
Two
DEATH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
Two
DEATH
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) = DEATH
C. DATE LAST MARRIAGE ENDED? June / 24 / 1994
MONTI;',. DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 2\1 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION 20.
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEARI :CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST 4/15/81 Poughkeepsie, NY Xi 1ST
2ND 6/24/94 Poughkeepsie. NY u X: 2ND
3RD = 3RD
4TH 0 4TH
I. being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true an
as to my right to enter into the marr~~e ~tate.
21 SIGNATURE OF GROOM ~ i .
B. ,;oW DID LAST MARRIAGE END? (3) ~ DIVORCE 3) L: ANNULMENT 21 _ JEATH
C. DATE LAST MARRIAGE ENDED? N OV . / 21 / 1 986
MONTH DAY YEAR
o ARE ANY FORMER SPOUSEiS) ALIVE? X YES = NO
IF P"IEVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMAT,ON
DATE OF DECREE PLACE ISSUED AGAINST WHOM
,MONTH. DAY. YEAR) (CITY. STATE:COUNTRY. IF NOT USA I SELF SPOUSE
12/18/78 Poughkeepsie, NY ~
11/21/86 Poughkeepsie, NY
~
22. SIGNATURE OF BRIDE ~
w
(f)
Z
W
(,)
:J
23. SUBSCRIBED ANO SWORN TO B RE ME
SIGNATURE OF TOWN 0"1 CITY CLERK ~
This license authorizes the marriage in New York State Df the bride and groom named above by any person 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 LERK 25. A. SOLEMNIZATION PERIOD BEGINS
aine H. Snowden Town Clerk
DATE 8/30/00
NY 12590
29
00
Deputy Town
DATE
Aug. 30, 2000
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON
~
{ SEAL }
"-v-l
NAME (PRINT)
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
SIGNATURE ~
MAILING ADDRESS
PO Box 324
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
IP
AM
12:30PM
10
8
31
00
A
27. TYPE OF CEREMONY
o 0 RELIGIOUS
28. PLACE WHERE MARRIAGE OCCURRED
lJ{ CIVIL
Dvr~
A. STATE NEW YORK B. COUNTY
29. OFFICIANT
NAME (PRINT)
LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
1i CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY ft, 0 91t /(a ~ ;t1 5 I e-.
I
NAME (PRINT)
SlGNATURE~
OOH-98 (11'118)