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COUNTY
Q[JfITOWN
DISTFUCT
NUMBER
REGISTER
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Shane B.
FIRST MIDDLE
I
STATE ALE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
Dutchess
Wappinger
1368
131
~ it-~/OU
~
L 0 SUPPLEMENTAL FILE
1. A FULL NAME
Bower
CURRENT SURNAME
FROM THE BRIDE
11. ~ FULL NAME Rosemarie A. Cullen
FIRST MIDDLE CURRENT SURNAME
3. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Vecchio
" SURNAME AFTER MARRIAGE Bowe r
,OPTIONAL. SEE REVERSE) 082-52-0434
SOCIAL SECURITY NUMBER
12 RESIDENCEA New York B. Dutchess
(STATE) (COUNTY)
". CHECK ONE 0 CITY LJ TOWN X VILLAGE
~~~C:FY Wappingers Falls
J. STREE"ADDRESS 11 Moran Avenue ZIP 12590
_ IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? XJ YES 0 NO
/25 /1958
YEAR
"-
N
B BIRTH NAME. IF DIFFERENT
C. CHECK ONE
AND
SPECIFY
3. A AGE
36
Dec.
41
13.8. DATE OF BIRTH
Nov.
MONTH
13. A. AGE
38. DATE OF BIRTH
DAY
YE~R
MONTH
14. EMPLOYMENT
4. EMPLOYMENT
A. USUAL OCCUPATION Cashier
B. TYPE OF INDUSTRY OR BUSINESS Unemployed
15, PLACE OF BIRTH New York, New York
(CITY, STATEiCOUNTRY IF NOT USA)
OJ
>--
0(
>--
W
A. USUAL OCCUPATION Cab Dispatcher
B. TYPE OF INDUSTRY OR BUSINESS Beekman Taxi
5. PLACE OF BIRTH St. Petersburg, Florida
(CITY. STATE COUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
Rose Blanda
6. FATHER
Patrick Vecchio
USA
A. NAME Gerald Eugene Bower
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Kathleen Donnelly
8. COUNTRY OF BIRTH USA
Third
3. COUNTRY OF BIRTH USA
18. 'lUMBER OF THIS MARRIAGE Second
19. PREVIOUS MARRIAGES
.A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVCRCE CIVIL ANNULMENT
One
DEATH
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
Two
DEATH
B. HOW 010 LAST MARRIAGE END? 3)XJ DIVORCE <31 0 ANNULMENT (2) == JE~TH
C. DATE LAST MARRIAGE ENDED? Ma v / 5 / 1999
MONTH DAY VEAR
D. ARE ANY FORMER SPOUSE,S) ALIVE? ~ YES ':= NO
3. -iQW OiD LAST MARRIAGE END? 13)Ki DIVORCE 31 == ANNULMENT :21D DEATH
". JATE ..AST MARRIAGE ENDED? June /22 / 1988
MONTH OA Y YEAR
o .i.RE ANY FORMER SPOUSEIS) ALIVE? ~ YES == NO
20. F ~REYICUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
JATE OF DECREE PLACE ISSUED AGAINST WHOM
MONTH. JAY. YEAR) (CITY. STATE'COUNTRY. IF NOT USAI SELF SPOUSE
6/27/88 Manhattan, New York
w
en
z
w
()
::i
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEAR) CITY. STATEiCOUNTRY. IF NOT USA) SELF SPOUSE
1ST 8/10/94 poughkeepsie, NY Xi 1ST
2ND 5/05/99 poughkeepsie, NY XJ 2ND
3RD 3RD
4TH -.J 4TH
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the mformatlon I provided is tru~nd tlJ8t I declare that no legal i~dimenl.elWsts
as to my right to enter into the marriage state,. ,'~"! /
21.SIGNATUREOFGROOM~ ~~~,-..':-<? -;6, /~--::-. ',..- ~'22.SIGNATUREOFBRIDE~(../lJ~i /iL..JU't-<...(" '~L,(_,_-C./. r\
- USE URRENT NA USE CURRENT NAME
23. SUBSCRIBED AND SWORN TO BEFORE ME De pu t y Town C 1 e r k
SIGNATURE OF TOWN OR CITY CLlERK ~
This license authorizes the marriage 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.
If checked. this license is to be used only for the purpose of a second or subsequent ceremony.
CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
Elaine Town Clerk
x:
DATE
Aug. 9, 2000
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
.-'-..
{ SEAL}
'-.,;-I
MONTH
DAY
YEAR
MONTH
DAY
YEAR
NAME (PRINT)
8/9/00 TIME
DATE
NY 12590 AM
'TA ZIP 2:45 PM
27. TYPE OF CEREMONY
oD RELIGIOUS CIVIL
9D OTHER. SPECIFY
SIGNATURE ~
M~'trGtg~E~ 4 ,
STRE
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
8
10
00
10
8
00
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY t),~
O. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF TOWN OF ~ VILLAGE 0
SPECIFY
o
NAME (PRINT)
SIGNATURE ~
DQH-98 (1198)
ZIP
31. WITNESS TO CEREMONY
::=~rJ~~
