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ST A TEOF NEW YORK I STATE FILE NUIIBER I
(THIS SPACE FOR STATE USE OM Y)
COUNTY Dutchess DEPARTMENT OF HEALTH
CI"""'OWN Wappinger ~ ~}lj)Oi)
~m~~~ 1368 AFFIDAVIT, LICENSE and
REGISTER 137 CERTIFICATE OF
NUMBER
MARRIAGE Lo SUPPLEMENTAL FILE --.J
FROM THE GROOM FROM THE BRIDE
1. A FUU NAME Bernard J. Normandin 11. A. FUU NAME Jennifer L. Kral
FIRST MIDDLE CURRENT SURNAME FIRST MIDDLE CURRENT SURNAME
..
N
B. BIRll-i NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Normand in
(OPTIONAL. SEE REVERSE) 468-98-1308
D. SOCIAL SECURITY NUMBER
12 RESIDENCEA. New York B. Dutchess
(STATE) ICOUNTY)
o CITY ~ TOWN 0 VilLAGE
Wappinger
D. STREET ADDRESS 9M White Gates Dr.
12590
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2. RESIOENCE A. New Yo r k
(STATE)
C CITY [1!: TOWN 0
Wappinger
13 Old Rt. 9
C CHECK ONE
AND
SPECIFY
114-56-1138
B Dutchess
(COUNTY)
VilLAGE
C. CHECK ONE
AND
SPECIFY
ZIP 12590
ZIP
D. STREET ADDRESS
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIUAGE? 0 YES ~ NO
13. A. AGE 35 13.B. DATE OF BIRTH July / 05 /1965
MONTH DAY YEAR
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VIUAGE? 0 YES ~ NO
3. A. AGE 30 3B. DATE OF BIRTH Oct. / 07 /1969
MONTH DAY YEAR
14. EMPLOYMENT
4. EMPLOYMENT
A. USUAL OCCUPATION Self-employed
B. TYPE OF INDUSTRY OR BUSINESS House Cleaner
15. PLACE OF BIRTH Mi nneanolis. Minnesota
(CITY. STATE/COUNTilV IF NOT USA)
A. USUAL OCCUPATION Retail Manager
B. TYPE OF INDUSTRY OR BUSINESS Price Chopper
5. PLACEOFBIRTH Plattsburgh, New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
Robert A. Kral
B. COUNTRY OF BIRTH USA
Charles Normandin
USA
A. NAME
7. MOTHER
17. MOTHER
Alice E. Dahlin
USA
1 B. NUMBER OF THIS MARRIAGE Fir s t
J. Rabideau
Barbara
USA
8. NUMBER OF THIS MARRIAGE First
A. MAIDEN NAME
A. MAIDEN NAME
B. COUNTRY OF BIRTH
B. COUNTRY OF BIRTH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
DEATH
DEATH
B. HOW DID LAST MARRIAGE END? (31 = DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEAll-i
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
i31 = ,~NNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) 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) I,CITY. STATE COUNTRY. IF NOT USA) SELF SPOUSE
MONTH JAY YEAR
D. ARE ANY FORMER SPOUSEIS) ALIVE? = YES = NO
20. IF PREVIOUSLY DIVORCED OR ANNUlED. PROVIDE THE ~OlLOWING INFORMATiON
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I, being duly sworn, depose and say. that to the bes
as to my right to enter into the marriage Sijlij' ,
21. SIGNATURE OF GROOM ~ ~
o 1ST
o 2ND ~
u 3RD ~
o 4~ ~
I that the information I provided is true and that I declare that no legal impediment exists
/
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23. SUBSCRIBED AND SWORN 0 BEF
SIGNATURE OF TOWN OR C lERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any rson 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 onl for the urpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT)~Elaine H. Snowden. Town Clerk
{ SEAL SIGNATURE~ 11.u.l~$,(/r\A&.L.. DATE 8/16/00 TIME MONTH DAY YEAR
MAILING ADORE ' AM
'-v-' P.O. Bo. 1:40 PM 08
ET A Zl
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
~SM~~~~~~~vJH5N P~E 0 rZRELlGIOUS
DATE AND AT THE TiME AND
PLACE INDICATED. 9 0 OTHER. SPECIFY
10
15
00
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENOS AT MIDNIGHT ON:
MONTH
DAY
YEAR
17
00
28. PLACE WHERE MARRIAGE OCCURRED
11- CIVil
A. STATE NEW YORK B. COUNTY \)u~
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VilLAGE OF
SPECIFY .lttvEiJJt!"lL ~1' )JV
, (
31. WITNESS TO
NAME (PRINT)
SIGNATURE ~
DQH.98 (1188)
NAME (PRINT)
SlGNATURE~
. ..