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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Roger G.
FIRST MIDDLE
23. SUBSCRIBED AND SWORN TO BEF RE ME
SIGNATURE OF TOWN OR CITY CLERK.
This license authorizes the marriage in New York Stat of the bride and groom named above by any person authorized
Relations Law 911 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
u 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
Ela1ne H. Snowden, Town Clerk
DATE 8/ 17/00
4, Wappingers Falls, NY 12590
CIlYITOWN STATE
. 27. TYPE OF CEREMONY
o N( RELIGIOUS
9 0 OTHER. SPECIFY
COUNTY DlITChe!H'l
~ow~ W~pp;nger
~~~:~: 1168
~~~I~J~R 1 40
1. A. FULL NAME
Grant
CURRENT SURNAME
B BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2 RESIDENCEA. New York
,STATEI
= CITY ~ TOWN 0
Wappinger
o STREET ADDRESS 2873 Rte. 9D
C. CHECK ONE
AND
SPECIFY
115-44-9735
B. Dutchess
(COUNTY)
VILLAGE
ZIP 12590
YES ~ NO
/1954
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? :J
3. A. AGE 45 3B. DATE OF BIRTH Oct. / 28
MONTH DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Truck Driver
B. TYPE OF INDUSTRY OR BUSINESS Gasland Trucking
5. PLACE OF BIRTH Valhalla , New York
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME Mar; orie Lockwood
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE Third
Burton L. Grant
USA
9. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
Two
DEATH
B. HOW DID LAST MARRIAGE END? 1.3\ O(OIVORCE 13) LJ ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? July / 5 / 2000
MONTH 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. DAV v"'<l) !CITY. STATElCOUNTRY. IF NOT USA) SELF SPOUSE
7119/85 Putnaml County, NY :J
7/5/00 Poughkeepsie, NY :J
:::J
21.
w
U)
Z
W
o
::i
~
{ SEAL }
'-.t-I
NAME (PRINT)
SIGNATURE.
MAILING ADDR!;.i
:20 Box j
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
TITLE
DATE
I"
STATE flUE NUMBER
(THIS SPACE FOR STATE USE ONL YI
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Margaret L.
FIRST MIDDLE
~
11. A. FULL NAME
Gressett
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
D. SOCIAL SECURITY NUMBER
New York
(STATE)
o CITY Xi TOWN
Wappinger
D. STREE'"ADDRESS 2873 Rte.
Gressett
042-60-3860
B. Dutchess
(COUNTY)
:J VILLAGE
12. RESIDENCE A.
C CHECK ONE
AND
SPECIFY
ZIP 12590
9D
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES Xl NO
13.A. AGE 41 13.B.DATEOFBIRTH March /9 /1959
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION
Disability
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Washington. D. C.
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME George L. Gressett
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Blanche Gery
USA
Second
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
DEATH
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) [J ANNULMENT 2' - DEATH
C. DATE c..AST MARRIAGE ENDED? May / 15 /1990
MONTH DAY YEAR
D ARE ANY FORMER SPOUSE,S) ALIVE? Xl YES C NO
20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH JAY. YEAR) iCITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST 5/15/90 poughkeepsie, NY X;
2ND
3RD r
DATE
by New York Domestic
25. B. SOlEMNIZATlON PERIOD
ENDS AT MIDNIGHT ON:
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
ZIP
AM
1 : 00 PM
8
18
00
10
16
00
28. PLACE WHERE MARRIAGE OCCURRED
1 =:IVIL
A. STATE NEW YORK B.COUNTY 0\.+1 ~C)~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
(blsho~
Sl'/ ~~/cr>
o CITY OF 1& TOWN OF 0 VILLAGE OF
SPECIFY Po \ ....:J'" \(p e.{?S ~ e
STATE ZIP
31. WITNESS TO CEREMO~Y +-
NAME (PRINT) (Yl, C-hC{ e./ . .. ~1...
SIGNATURE. ~J. ,)/{f.....::7J