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COUNTY Dutchess
CITYfTOWN Wappinger
~~~~f: 1368 .
~~~I:~~R 91
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
.J::I~I~D~E Ryan Kn~RNT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Yi
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Elaine Knapp
MIDDLE CURRENT SURNAME
---1
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSEb60_72_5539
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANY B.Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D. STREET ADDREss37 Seitz Terrace
ZIP 12603
o YES If] NO
)'985
YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
D. SOCIAL SECURITY NUMBER 129-72-6531
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY otJ TOWN 0 VILLAGE
AND P hk .
SPECIFY oug eepsle
D. STREET ADDRESS 37 Seitz Terrace ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
07 /24 /1980
MONTH DAY YEAR
3. A. AGE 30
3B. DATE OF BIRTH
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13.A. AGE25 13B.DATE OF BIRTH 01 ~3
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Somers CSD
15. PLACE OF BIRTH Carmel, NY
(CITY, STATE / COUNTRY IF NOT USA)
4. EMPLOYMENT
A. USUAL OCCUPATION Mechanic
B TYPE OF INDUSTRY OR BUSINESS Automotive
5. PLACE OF BIRTH Pouahkeepsie. NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME .Jonathan Ronald Knapp
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Valentina Milanczuk
B. COUNTRY OF BIRTH Belgium
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
16. FATHER
A. NAME Ralph LiVeli
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Dawn Edith D'Amico
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEdTH
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / (,
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
.
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
a:
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1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I duly swellr/affirm. dep'ose and say, ~at 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 nghtto enter Into the marn~ge st ~
, />' V " ,r",
21 SIGNATURE OF GROOM~ 2~,SIGNATURE OF BRIDE~ (,l OJ..JL..l/\.J. ~I (I gJ
USE cu i, USE CURRENT NAME '1!
23 SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME ' ,) wI' ^-- to /26/2010
SIGNATURE OF TOWN OR CITY CLERK ~ <-J'-{ l.J . DATE
This license authorizes the rTlf"riage 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
{ } NAME (PRINT) John C. Master
TIME MONTH YEAR MONTH
SEAL SIGNATURE ~
'- -.J MAI~ ~~aWe AM 07
-v- 02:39PM
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
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YEAR
23 2010
26
2010
09
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28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUN!RP/<0'E"SY"
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
~
?'I CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY {;~~~E--
NAME (PRINT)
SIGNATURE~ '
DOH-98 (09/2009)