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STATE :,OF~;NEWNORK;~JT
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael Peter
FIRST MIDDLE
o 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
st D my knowledge and belief that the information I provided is true and that I declare that no legal impediment eXIsts
22.SIGNATUREOFBRIDE~ ~ ~ //"~h~'
" ", USE CU~
Deputy Town Clerk DATE J y 19. 2000
This license authorizes the marriage in New York State f 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.
o If checked, this license is to be used on for the of a second or su uent ceremon .
24. TOWN OR ClEREKlaine 25. A. SOLEMNIZATION PERIOD BEGINS
Town Clerk
COUNTY
~ITOWN
blSTRICT
NUMBER
REGISTER
NUMBER
Dutchess
Wappinger
1368
111
1. A. FULL NAME
Pung
CURRENT SURNAME
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A New York
(STATE)
C. CHECK ONE 0 CITY rI. TOWN
AND W i
SPECIFY app nger
D. STREET ADDRESS 9 Fox Hill Road ZIP 12590
E. IS RESIDENCE WITHiN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES!i NO
Oct. /10 /1971
MONTH DAY YEAR
079-52-8544
B Dutchess
. (COUNTY)
o VILLAGE
3. A. AGE
28
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Landscape Design
B. TYPE OF INDUSTRY OR BUSINESS Twin J' s Lawn Care
5. PLACE OF BIRTH Cold Spring. New York
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
Bruce Pung
USA
Sucato
Rosalie
USA
8. NUMBER OF THIS MARRIAGE Fir s t
A. MAIDEN NAME
B. COUNTRY OF BIRTH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) AUVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, that to the
as to my right to enter into the marriage 5ti'te.
.
21. SIGNATURE OF GROOM ~
w
en
z
w
u
::i
Sf ATE FILE NUllBER
(THIS SPACE FOR STAn: USE OM..Y)
"l
/ ~ \1\ 0'1)
L 0 SUPPLEMENTAL FILE
-.J
11. A FULLtwE
FROM THE BRIDE
Susan Ann
FIRST MIDDLE
Murphy
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURtwE AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B Dutchess
(STATE) . (COUNlY)
o CITY 1:J TOWN 0 VILLAGE
Wappinger
9 Fox Hill Road
PUNG
073-70-3820
C. CHECK ONE
AND
SPECIFY
ZIP 12590
DYES 00 NO
18 /1971
YEAR
D. STREET ADDRESS
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 28 13.B. DATE OF BIRTH OC t . /
MONTH
DAY
14. EMPLOYMENT
A. USUAL OCCUPATION School Teacher
B. TYPE OF INDUSTRY OR BUSINESS Arlington High School
15. PLACE OF BIRTH Brewster. New York
(CITY. STATEICOUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Daniel Murphy
USA
RoseMary' LaFoch
USA
First
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW 00 LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE lAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
25. B. SClI.J:MNIZATlON PERlOIl
ENOS AT MIDNIGHT ON:
DATE
NY
7/19/00
12590
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
AM
12:30PM
00
9
17
00
7
20
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY iJu.! (!h~
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~TOWN OF 0 VILLAGE OF
SPECIFY East /JSIJ,(///
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
26. SOLEMNIZATION OCCURRED
Y
27. TYPE OF CEREMONY
o ~EUGIOUS 1 0 CIVIL
9 0 OTHER, SPECIFY
tJV
29. OFFICIANT
NAME (PRINT)
TITLE ~/mn <1HlCltt Pne~r
~1'2-IOO
I
. Pi! jf~
rt-W
NAME (PRINT)
SIGNATURE ~
00tM8 ~
STATE
G-~h ,. i