143
\.
'-
..
N
w
~
Oti
'"
lI'\
N
.....
~ >"' >1::
:nZ
ill <(
OA C
~CIl -
-C~...; ~ u..
:5u..
~~ ~ <(
Q~ ~
~ CIl g
u; ~ ~
8~()
"!::
~....
;;:0..
"0..
""ell
\, ~
.-- A
_. t- '0
C)ell
;;:0
i~
....
O.jj
~l-l
~ 0 a:
-"-I W
~.jj!!1
u'lg~
5::E: !:1
c <
< ....
>--.:t ~
~('t") ~
~ Cf)
j;
Zi:z
St:Q W
~~~ ~
"a:-
~~~ (J
"""\t)W
~ ~
) i=
,-,l a:
W
"" W~~ (J
...ffi-n
i!5~
"..
-
-
51 A TE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
James C.
FIRST MIDDLE
COUNTY
~fTOWN
DISTRICT
NUMBE!A
REGISTER
NUMBER
Dutchess
Wappinger
.1368
143
Seckler
11. A. FUll NAME
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
1. A FUll NAME
CURRENT SURNAME
B. BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2. RESIDENCEA. New York
,STATE)
o CITY ~ TOWN 0
Wappinger
o STREET ADDRESS 34 Montfort Road
C. CHECK ONE
AND
SPECIFY
091-48-6600
B. Dutchess
(CCUNTY)
VILLAGE
C. CHECK ONE
AND
SPECIFY
12. RESIDENCE A.
ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3B.DATEOFBIRTH Sept. /17 /1968
MONTH DAY YEAR
3. A. AGE
31
13. A. AGE
14. EMPLOYMENT
4 EMPLOYMENT
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
/ ~,,1/i'
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Brigitte K.
FIRST MIDDLE
.J
Crowther
CURRENT SURNAME
Seckler
079-66-9806
B. Dutchess
I CCUNTYl
VILLAGE
31
A. USUAL OCCUPATION Mechanic
B. TYPE OF INDUSTRY OR BUSINESS Dutchess Resource
5. PLACE OF BIRTH Bronx, New York
(CITY. STATE/COUNTRY IF NOT USA)
A. USUAL OCCUPATION Sales
Reco . B. TYPE OF INDUSTRY OR BUSINESS Jane sway
15. PLACE OF BIRTH Newburgh, New York
(CITY. ST A TElCOUNTRY IF NOT USA)
6. FATHER
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
William Crowther
USA
17. MOTHER
A. MAIDEN NAME Amalia Gazzola
8. COUNTRY OF BIRTH USA
lB. NUMBER OF THIS MARRIAGE First
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
A. NAME Robert Seckler
B. COUNTRY OF BIRTH USA
7 MOTHER
A. MAIDEN NAME Carol Duffy
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE First
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
DEATH
B. HOW DID LAST MARRIAGE END? {3\ 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3\ 0 ANNULMENT
/ /
(2\ = DEATH
B. HOW DID LAST MARRIAGE END? (3) C DIVORCE
C. DATE LAST MARRIAGE ENDED?
3\ = ANNULMENT
/ /
12\ = DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSEiSl ALIVE? 0 YES 0 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
MONTH QA Y '(EAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? == YES = NO
20. 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
1ST u 1ST
2ND :J 2ND
3RD u 3RD
4TH 4TH ~
I, being duly sworn, depose and say at to the be~ of my kn NI belief that the Information 1 provided IS true and that I declare that no legal Impediment eXists
as to my right to enter into the marri .ge state. {! ~
21. SIGNATURE OF GROOM ~ ~ 2~. SIGNATURE O~ f:f;f fl ~?ft;;;.Rii:..M{}.t:L2.~~
23 Depu ty Town CIeri( DATE Aug. 24, 2000
This license authorizes the marriage in New York S ate 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 on for the u se of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
Elaine H. Snowden, Town Clerk
DATE 8/24/00
NY 12590
Sit
27. TYP5PF CEREMONY
o 8'1lELlGIOUS 1 C CIVIL
9 C OTHER. SPECIFY
w
en
z
w
(J
::::i
.-^-.
{ SEAL }
'-t-I
NAME (PRIN
SIGNATURE ~
M~tiNltg~
S
I CERTIFY THAT! SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
25. B. SQlEMNIZA TlON PERIOD
ENOS AT MIDNIGHT ON'
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
:30
AM
PM
8
25
00
10
23
00
2B. PLACE WHERE MARRIAGE OCCUR::n
A. STATE NEW YORK B. COUNTY \~('Ss
tf- ( 8ct~ r
?' /<<" /~ tJtr/
I ' 1:20 V
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~~E OF
SPECIFY W~JVGt;eS 'r/fU s
TiTlE
NAME (PRINT)
SlGNATURE~