129
......
~
'-'
u:::c
;::
I
uJ
'-'
uJ
a:
!;! a:
~::c~
(fl ::;
(fl :0
uJ i:Q Z
~CX)g
~ N~
> lli
!!, a:
'-' >-
uJ (fl
"-
'"
~~a
~~;:: W
:i!~~ ~
>-WZ .....
~<3~ 0
~<ig u:
5... ~
~O a:
~~W
W~C!i 0
b~"
z:;~
51 A 1E OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Jonathan W.
FIRST MIDDLE
21. SIGNATURE OF GROOM ~
23. SUBSCRIBED AND SWORN rEnlEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of t e bride and groom nameo above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
:J If checked. this license is to be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK I 25. A. SOLEMNIZATION PERIOD BEGINS
Elai e H. Snowden, Town Clerk
DATE 8/4/00
24, Wappingers Falls, NY 12590
CITYfTOWN STATE
26. SOLEMNIZATION OCCURRED 27. TY~OF CEREMONY
TIME MO. DAY YEAR 0 B"'RELlGIOUS
COUNT
mt"fT( J ~
- OISTR!C~
NUMBER
REGISTER
NUMBER
ntlt~hp-ss
W.qppinger
1168
1 ?Q
1. ~. FULL NAME
C'mP-l.qno
C RENT SURNAME
a.
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
J SOCIAL SECURITY NUMBER 134-70-] 826
2. RESIDENCEA. New York B. Dutchess
i ST A TE) I COUNTY)
C CHECK ONEC CITY ~ TOWN 0 VILLAGE
AND
SPECIFY Poughkeepsie
D STREET ADDRESS 18 Ricky Lane ZIP 12601
=. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? :J YES !]{ NO
3. A. AGE 23 3B.DATEOFBIRTH Feb. /02 /1977
MONTH DAY YEAR
4. EMPLOYMENT
w
>-
'"
>-
<I)
A. USUAL OCCUPATION Manufacturing Operator
B TYPE OF INDUSTRY OR BUSINESS Phi 1 ips
5. PLACE OF BIRTH ,cIX~:;~~~;,.;RFsN~TeUSA~ew York
6. FATHER
A. NAME William R. Copeland
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME
B COUNTRY OF BIRTH
Lynne A. Fink
USA
First
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
3. ~ow DID LAST MARRIAGE =ND? i31 C DIVORCE
v. uATE LAST MARRIAGE ENDED?
131 = ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY
D. ARE ANY FORMER SPOUSE(SI ALIVE? C YES C NO
,0. F PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
MONTH. DAY. YEARI 'CITY. STATE/COUNTRY. IF NOT USAI SELF SPOUSE
YEAR
1ST
2ND
3RD
4TH
I. being duly sworn, depose and say
as to my right to enter into the marri
:::J
--,
w
tJ)
Z
W
o
::::;
~
{ SEAL }
'-v-I
NAME (PRINT
SIGNATURE ~
MAILING ADORES
PO Box
STREET
I CERTIFY THAT I SOLEMNIZED
Tl-IE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
9 0 OTHER. SPECIFY
29. OFFICIANT
NAME [PRINT)
TITLE
NAME (PRINT)
SlGNATlURE ..
DOH-98 (1198)
r-- STATE FILE NUMBER I
(THIS SPACE FOR STATE USE ONLY)
.~ ,JlI/OD
Lo SUPPLEMENTAL FILE -.J
FROM THE BRIDE
Kira n R.qrh~ran
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
v. SURNAIoIEAFTER MARRIAGE Copeland
IOPTlONAl - SEE REVERSE)
D SOCIAL ~ECURITY NUMBER 091-64-94] 7
12 RESIDENCE.\. New York B Dutchess
(STATE) ,COUNTYI
v. CHECK :~E 0 CITY ~ TOWN [] VILLAGE
AND
SPECIFY Wappinger
D. STRE~.\.DDRESS 2 Russ Place zIP12590
11. ~. FULL:w.IE
E. IS RESiDtNCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE?
13. A. AGE 28 13.B. DATE OF BIRTH Dec. /06
MONTH DAY
YEs.}C NO
/1971
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Store Manager
B. TYPECF INDUSTRY OR BUSINESS Structure
15. PLACE OF 31RTH Chone. Ecuador
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. N~E Humberto E. Barberan
B. COUNTRY OF BIRTH Ecuador
17. MOTHER
A. MAIDEN NAME F.vi G Roor; elIP?:
3. COUNTRY OF BIRTH Ecuador
18. NUMBER 2F Tl-IIS MARRIAGE Firs t
19. PREVIOUS IdARRIAGES
~. NUMBE.= OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVCRCE CIVIL ANNULMENT
JEATH
3. 'iOW:.O _~T MARRIAGE END? (3\ 0 DIVORCE
v. DATE _AST MARRIAGE ENDED?
3\ C ANNUL'AE~T
/ /'
2' C DEATH
MONTH DAY
DARE A/>,Y "ORMER SPOUSE(SI ALIVE? C YES C NO
20. F PREVICL-SLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING iNFORMATION
DA TE :" DECREE PLACE ISSUED AGAINST WHOM
'MONT~ DAY. YEAR) ICITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
YEAR
1ST
2ND
3RD
4TH
at the IntDrmanon I provided is true and that I declar~ that no)egal Impediment exists
, , "/ ~
J::A /, /) /'~1 :~ /1
22 SIGNATLiRE OF BRIDE ~ ....-'.... - L '-.;../ / -- - ~ u.<_
I :JSE CURRiNT NAME
~eputy Town/Clerk '
DATE Aug. 4, 2000
by New York Domestic
25. B. SOlEMNIZA T10N PERIOD
ENDS AT MIDNIGHT ON:
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
AM
ZIP I 2: 45 PM
08
05
00
10
03
00
JIVIL
28. PLACE WHERE MARRIAGE OCCUR~
A. STATE NEW YORK B. COUNT~TCH(S5
~. C, ~J~5r
,,~/ :lc-n;
I '
/:J. S-, 0
ZIP
REMONY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF Jd""VILLAGE OF
SPECIFYW~~R5 (;,UJ,.
NAME (PRINT)
SlGNATUFE ..