112
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York tate 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.
- If checked, this license is to be used only for the pu se of a second or subsequent ceremony.
CLERKl 25. A. SOLEMNIZATION PERIOD BEGINS
E ai Town Clerk
DATE 7 /20/00
NY 12590
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael R.
COUNTY
1llI2l'r'fTOWN
"~lstRICT .
NUMBER
REGISTER
NUMBER
Dutchess
Wappinger
1368
112
1. A FULL NAME
Pullis
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:X TOWN C
Wappinger
D. STREET ADDRESS 29 Regency Drive
C. CHECK ONE
AND
SPECIFY
133-74-0267
B. Dutchess
(COUNTY)
VILLAGE
ZlP
12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE 26 3B. DATE OF BIRTH March / 8
YES Xi NO
/1974
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION
MONTH DAY
Plumber
B. TYPE OF INDUSTRY OR BUSINESS House Plumbing & Htg.
5. PLACE OF BIRTH Poughkeepsie. New York
(CITY. STATE,COUNTRY IF NOT USA)
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
George Pullis
USA
Christine Woods
USA
First
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. ,"OW DID LAST MARRIAGE END? 31 = DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) = ANNULMENT
/ /
(21 = DEATH
MONTH DAY "EAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? = YES = NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED ~GAINST WHOM
.MONTH. DAY. YEAR) .CITY. STATE'COUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
W
en
z
W
o
~
24. TOWN OR
.-^-,
{ } NAME (PRINn
SEAL SIGNATURE ~
'-v-I ~t)N1fg~R!j2 4 .
S EET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE (NDICA TED.
ST T
27. TY~ OF CEREMONY
o ~ELlGIOUS
9 L: OTHER. SPECIFY
Wappin ers Falls.
ITYIT WN
26. SOLEMNIZATION OCCURRED
TIME M DAY YEA
TITLE ""it c . .
s
SIGNA TURE ~
DOH-98 (1/98)
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
~ ?/IS'/O D
I
Lo
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SUPPLEMENTAL FILE
1,. A. FULL NAME
FROM THE BRIDE
Kendra M.
Grimshaw
CURRENT SURNAME
FIRST
MIDDLE
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
O. SOCIAL SECURITY NUMBER
New York
{STATE!
c CITY ~ TOWN
Wappinger
o. STREETAODRESS 29 Regency Drive
12. RESIDENCE A.
Pullis
054-72-9563
B. Dutchess
ICOUNTY!
VILLAGE
C. CHECK ONE
AND
SPECIFY
liP
12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
13. A. AGE 25 13.B. DATE OF BIRTH July /16 /1975
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Nail Tech
B. TYPE OF INDUSTRY OR BUSINESS Hair La Coy
15. PLACE OF BIRTH Carmel. New York
(CITY, STATEiCOUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME Mildred Weit
B. COUNTRY OF BIRTH USA
lB. NUMBER OF THIS MARRIAGE Firs t
George Grimshaw
USA
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? 131 = DIVORCE '.31 L: ANNULMENT
C. DATE LAST MARRIAGE ENDED? / /
\10NTH ~A Y YEAR
D. ARE ANY FORMER SPOUSEiSI ALIVE? = YES = NO
20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WI-10M
(MONTH. DAY. YEARI ICITY STATE-COUNTRY. IF NOT USA) SELF SPOUSE
(2) = JE.';"'"L.;
,.
Deputy Town
DATE July 20. 2000
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON'
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
ZI
10:15AM
PM
00
7
21
00
9
18
1 c::: CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY.P. Ird~,?
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
[J CITY OF CJA6WN OF CJ VILLAGE OF
SPECIFY t:.;; sj., /<,,/ /
~'es-;-
/al5J 3.
ZIP
31. WITNESS TO CEREMONY
NAME (PRINn