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COUNTY
-P-rrOWN
DISTRICT
NUMBER
REGISTER
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael E.
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
Dutchess
Wappinger
1368
113
/' <JI'~~()
L 0 SUPPLEMENTAL FILE
..J
1. A. FULL NAME
Murphy
CURRENT SURNAME
FROM THE BRIDE
Diane L. Myers
FIRST MIDDLE CURRENT SURNAME
8 BIRTH NAME (MAIDEN NAME), IF DIFFERENT Covert
C. SURNAME AFTER MARRIAGE Mu rp h Y
(OPTIONAL. SEE REVERSE) 102 68
D SOCIAL SECURITY NUMBER - - 9979
12. RESIDENCE A New York B Dutchess
,STATE) . ICOUNTY)
[J CITY ~ TOWN [J VILLAGE
Poughkeepsie
D STREET ADDRESS 348 South Road
11. A. FULL NAME
FIRST
MIDDLE
8 BIRTH NAME, IF DIFFERE'IT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER
2. RESIDENCEA. New York
I,STATE!
= CITY ~ TOWN 0 VILLAGE
Poughkeepsie
D STREET ADDRESS 348 South Road
113-50-3628
B.
Pcutchess
( OUNTY)
C. CHECK ONE
AND
SPECIFY
12601
C. CHECK ONE
AND
SPECIFY
12601
Z:P
ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? YES x: NO
13.A.AGE 31 13.8. DATE OF BIRTH April/18 /1969
MONTH :JAY YEAR
YES Ki NO
/1968
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION
Homemaker
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
3. A AGE 31 38. DATE OF BIRTH Nov. / 14
MONTH DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Elec trician
B. TYPE OF INDUSTRY OR BUSINESS IBEW 363
5. PLACE OF BIRTH Manhattan, New York
(CITY. STATEiCOUNTRY IF NOT USA)
8. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Tarrytown, New York
(CITY. STATEiCOUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
Frank William Covert
USA
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
Joseph Christopher Murphy
USA
Julie Venier
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE Second
Dorothy V. Scheid
A. MAIDEN NAME
8. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE First
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
A. MAIDEN NAME
DEATH
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
DEATH
B. HOW DID LAST MARRIAGE "ND? 131:: DIVORCE
C. DATE LAST MARRIAGE ENDED?
3) :: ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID CAST MARRIAGE END? (3lXJ DIVORCE 13) = ANNULMP,T 2 = :EATH
C DATE :..AST MARRIAGE ENDED? Oct. / 6 / 1999
MCNItt DAY '''EAR
D. ARE ANY FORMER SPOUSEiS) ALIVE? 1t; YES = NO
20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWIi'<G .NFORMATION
DATE OF DECREE PLACE ISSUED .\GAINST WHOM
(MONTH. DAY. YEARI (CITY. STATEiCOUNTRY. IF NOT USAI SELF SPOUSE
10/6/99 Dutchess Co.. NY XX
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. DAY. YEAR) CITY. STATEfCOUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I, being duly sworn, depose and
as to my right to enter into the m
21. SIGNATURE OF GROOM ~
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23. SUBSCRIBED AND SWORN TO BE ORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York St e 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.
:J If checked. this license is to be used onl for the purpose of a second or subsequent ceremony,
24. TOWN OR CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
Elaine Town Clerk
DATE 7 /21/99
Wappingers Falls, NY 12590
I N
9
19
00
by New York Domestic
25.8. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
,-'-..
{ SEAL }
~
NAME (PRINT)
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
9:45 AM
PM
SIGNATURE
'1ltiN1tJ~R~4 ,
S E
~~~R~~RT~~~ IO~O~~N:.z:~ 26. SOLEMNIZATION OCCURRED
SONS NAMED ABOVE ON THE TIM M. DAY Y R
DATE AND AT THE TIME AND
PLACE INDICATED.
7
22
00
A
27. TYPE OF CEREMONY
o ~GIOUS
9 0 OTHER. SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY Dl.\+'-~PS ~
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LLAGE OF
SPECIFY ~ t'f i 0 ()I1& .~ U "
1 = CIVIL
L{:CO
DO
29. OFFICIANT
NAME (PRINT)
'R.~c.~\r
A V~".1t+ 1\ ""t. tl 1) 0
I
N J;'
STATE
TITLE
NAME (PRINT)
SlGNATURE~