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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Bill J.
COUNTY
aorlTOWN
DISTRICT
NUMBER
REGISTE.'l
NUMBER
Dutchess
Wappinger
1368
127
A. FULL NAME
Hoyt
CURRENT SURNAME
FIRST
MIDDLE
B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER
2. RESIDENCE A New York
(STATE)
= CITY lX TOWN
Wappinger
D STREET ADDRESS 14 Dose Road
C. CHECK ONE
AND
SPECIFY
376-28-7285
B. Dutchess
(COUNTY)
VILLAGE
ZIP
12590
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
April /25 /1931
MONTH DAY YEAR
3. A. AGE
69
3B. DATE OF BIRTH
W
I-
<
I-
(fJ
4. EMPLOYMENT
A. USUAL OCCUPATION
Retired
B. TYPE OF INDUSTRY OR BUSiNESS
5. PLACE OF BIRTH Saginew, Michigan
,CITY . STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME
8. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
8. NUMBER OF THiS MARRIAGE
Earl Hoyt
USA
Eva Gubbins
USA
Second
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
One
8. HOW DID LAST M.~RRIAGE "NO?
31 = DIVORCE '31 0 ANNULMENT (21 ~ DEATH
Jan. / 26 / 1999
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? = YES ~ NO
YEAR
10 IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE ?LACE ISSUED AGAINST WHOM
(MONTH. 'JAY. YEAR) CITY. STATE COUNTRY, IF NOT USAI SELF SPOUSE
I STATE FILE NUMBER I
(THIS SPACE FOR STATE USE ONLY)
~ ~Ii}D1J
Lo SUPPLEMENTAL FILE ~
11. A. FULL NAME
FROM THE BRIDE
Marion
FIRST
Crook
MIDDLE
CURRENT SURNAME
Silvieus
Crook
055-20-6171
B. BIRTH NAME .MAIDEN NAME. iF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
O. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B Dutchess
,STATE) . (COUNTYI
o CITY::{] TOWN C VILLAGE
Fishkill
41 Lake Road
C. CHECK ONE
AND
SPECiFY
D. STREET ~DDRESS
ZIP 12524
YES Xi 'K)
/1925
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 74 13.B. DATE OF BIRTH Aug. /23
MONTH DAY
VE.~R
14. EMPLOYMENT
A. USUAL OCCUPATION
Retired
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF SIRTH Monticello, New York
(CITY. STATe-COUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Leland Silvieus
USA
Flora Palmer
USA
Second
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEAT'"
One
B. HOW DID cAST MARRIAGE ,,~D? i31 C DIVORCE J\ _ ANNUL\'E~- 2' X =='--
C. DATE ..AST MARRIAGE ENDED? Aug. // 9 ,/ 1997
MONTH DAY -'E~R
D ~RE ~NY "OR MER SPOUSEiS) ALIVE? = YES 4i NO
20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING ,NFORMA-'CN
DATE:F DECREE PLACE ISSUED ~GAINST WHCl,4
,MONTH CAY. YEAR) CITY. STATE/COUNTRY. IF NOT USAI SLr SPOUSE
1ST D 1ST
2ND C 2ND
3RD C 3RD
4TH 0 4TH
t, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal Impeoiment eXls:s
as to my right to enter into the marri~g tate. . /lV1 - r. /J
21. SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~ / I f~""""" ~
, USE CURRENT NAME
DATE Aug. 1. 2000
by New York Domesric
23. SUBSCRIBED AND SWORN TO BEFORE M
SIGNATURE OF TOWN OR CITY CLERK~
This license authorizes the marriage in New York ate of the bride and groom named above by any person authorized
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.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
Elaine Town Clerk
DATE 8/1/00
NY 12590
STATE
27. TYPE OF CEREMONY
o ~ RELIGIOUS
00 90 OTHER. SPECIFY
w
en
z
w
o
::::i
~
{ SEAL }
'-.,-I
NAME (PRIN
SIGNATURE
MAII.ING.AODXDRE;S~ 4 ,
~u ~ Jl Wappingers Falls,
STREET CITYrroWN
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED
THE MARRIAGE OF THE PER,
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR
DATE AND AT THE TIME AND AM
PLACE INDICATED 1 : 00 PM
29. OFFICIANT James AI. Neevel
NAME (PRINT! · .
SIGNATURE ~ ~ a-....-,-tl. /l~"~-
MAILING ADDRESS ~
1580 Route 376, Napp:i.nqers Falls,
STREET CITYITOWN
30. WITNESS TO
Deputy Town Clerk
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON'
TIME
MONTH
MONTH
YEAR
DAY
YEAR
JAY
ZIP
AM
12: 30PM
8
2
00
9
30
00
28. PLACE WHERE MARRIAGE OCCURRED
1 = ::::VIL
A. STATE NEW YORK B. COUNTY ~tchess
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
TITLE Ordained Clergy
DATE ~-t: ~ ~
New York 12590
STATE
NAME (PRINT)
SIGNATURE ..
DOH-98 (tl98)
~ CITY OF :J TOWN OF = VILLAGE OF
sp~qhKeepsie
NAME (PRINT)
SIGNATURE ..