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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
William Huckins
FIRST MIDDLE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
"I
Dutchess
Wappinger
1368
141
"DUPLICATE COpy"
~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Elizabeth Frances
FIRST MIDDLE
Lancto
CURRENT SURNAME
Allen
CURRENT SURNAME
11. ~. FULL NAME
B. BIRTH NAME IF DIFFERENT
B BIRTH NAME "MAIDEN NAME). IF DIFFERENT
Allen
073-56-8103
New York B Dutchess
(STATE) . (COUNTY)
C CITY Xi TOWN = VILLAGE
Wappinger
32 Sucich Place
565-33-7448
C. SURNAME AFTER MARRIAGE
,OPTIONAL - SEE REVERSE)
SDCIAL SECURITY NUMBER
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SDCIAL SECURITY NUMBER
2 RESIDENCE A Pennsylvania B. Franklin
,STATE) (COUNTY)
C. CHECK ONE C CITY ~ TOWN = VILLAGE
~~~CIFY Chambersburg
D STREET ADDRESS 150 Meadow Creek Drive ZIP 17201
12. RESIDENCE~.
". CHECK GNE
AND
SPECIFY
ZIP 12590
STREET ~DDRESS
:. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? _ YES x: NO
13. A. AGE 25 13.B. DATE OF BIRTH March / 19 /1975
MONTH DAY YEAR
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES iXi NO
3. A. AGE 26 3B.DATEOFBIRTH June /2, /1974
MONTH DAY YEAR
14. EMPLOYMENT
4. EMPLOYMENT
A. USUAL OCCUPATION Student - Military
B. TYPE OF INDUSTRY OR BUSINESS Syracuse Law School
15. PLACE OF BIRTH Beacon, New York
(CITY, STATE COUNTRY IF NOT USA)
A. USUAL OCCUPATION Engineer
B. TYPE OF INDUSTRY OR BUSINESS Ingersoll-Rand
5. PLACE OF BIRTH Oakland, California
(CITY. STATECOUNTRY IF NOT USA)
16. FATHER
A_ NAME
B COUNTRY OF BIRTH
17. MOTHER
John Lawrence Lancto
USA
6, FATHER
A. NAME
B. COUNTRY OF BIRTH
7_ MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Robert Lee Allen
USA
Mary Nell Huckins
USA
Edith Fendell
A_ MAIDEN NAME
3. COUNTRY OF BIRTH USA
lB. '<UMBER OF THIS MARRIAGE Firs t
19. PREVIOUS MARRIAGES
A. NUMBE=i OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
First
B. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? (3) = DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DE~TH
3 HOW CiD .AST MARRIAGE END? (3) = DIVORCE
~. DATE _AST MARRIAGE ENDED?
3) = ANNLc'.IE'<T
/ /
,21 = JEATH
""ONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? = YES = 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
MCNTH uAY YEAR
: ARE ANV FORMER SPOUSE(S) ALIVE? = YES = NO
20 F ~REVICI.:SL Y DIVORCED OR ANNULED. PROVIDE THE FOLLOWING ,NFCRMATION
DATE CF DECREE PLACE iSSUED AGAINST WHOM
MONTH. :AY. YEAR) (CITY, STATE,COUNTRY. IF NOT USA) SELF SPOUSE
1 ST 0 = 1 ST
2ND 0 2ND
3RD 0 '--- 3RD
~ 0 '--- ~
I. being duly sworn, depose and say, that to the best Df my knowledge and belief that the ,nrormallon I provided is true and that I declare that no legal impediment eXists
as to my right to enter Into the marriage 51 e, ~
21. SIGNATURE OF GROOM ~
22 SIGNATURE OF BRIDE ~
w
en
z
w
o
:::i
JSE CURRENT NAME
23 DATE Aug. 18, 2000
This license authorizes the marriage in New York St te of the bride and groom named above by any person authorized by New York Domestic
Relations Law 911 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
Elaine H Town Clerk
25. B SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
~
{ SEAL }
'-.-'
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
NAME (PRINT)
DATE 8/18/00
NY 12590
TATE
27. TYPE OF CEREMONY
o ~ELlGIOUS
SIGNATURE ~
MAILING ADORE
PO Box 324.
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
10: 15AM
PM
8
19
00
10
17
00
Wappingers Falls,
ITY rrOWN
26, SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
ZIP
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COLNTY W;l,~tC-{.ts~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF CJ TOWN OF .it VILLAGE OF
SPECIFY ? eek ~ k;.ll
1 = .::;IVIL
2."1>0 9 0 OTHER. SPECIFY
TITLE
M ; VI ; ';;('6r
/ ()tl?~/ () 0
NAME (PRINT,
SIGNATURE ~