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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFADAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
F.
MIDDLE
COUNTY
~OWN
DIS~"'ICT
NUMBER
REGISTER
NUMBER
Dutchp-RR
WappingP-T
l1M~
107
1 A. FULL NAME
James
FIRST
Bosch IP
CURRENT SURNAM
Cl.
N
S BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 080-70-3659
D SOCIAL SECURITY NUMBER ___ __ ____
2 RESIDENCE A New York B, DutcheRR
(STATE) (CQUN'I'Y)
C. CHECK ONE [J CITY XJ TOWN [] VILLAGE
AND W . ..
SPECIFY app1nger
D STREET ADDRESS 68 Easter Rd. ZIP 12512
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? [] YES ~ NO
/18 /1972
DAY YEAR
3. A. AGE
28
38. DATE OF BIRTH
June
MONTH
4 EMPLOYMENT
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A, USUAL OCCUPATION Self-Employed
B, TYPE OF INDUSTRY OR BUSINESS Builder
5, PLACE OF BIRTH Cold Spring New York
(CITY, STATE-COUN'l'RY IF NO'l'"USA)
6, FATHER
A, NAME James F. Bosch .Tr.
B, COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME
Madeline Lake
USA
First
g, COUNTRY OF BIRTH
8, ~UMBER OF THIS MARRIAGE
9, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
g, HOW DID LAST MARRIAGE END? ,31 = DIVORCE
~. DATE LAST MARRIAGE ENDED?
(21 0 DEATH
3) iJ ANNULMENT
/ /
MONTH DAY YEAR
0, ARE ANY FORMER SPOUSEiS\ ALIVE? = YES iJ NO
10. F PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
IMONTH, DAY, YEAR) ICITY. STATE-COUNTRY, IF NOT USA) SELF SPOUSE
r
STATE ALE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
~A-r 9/ -z/ 07)
L 0 SUPPLEMENTAL FILE
~
11. A, FULL NAME
FROM THE BRIDE
T.
MIDDLE
Morrisroe
CURRENT SURNAME
Kathleen
FIRST
S, BIRTH NAME I MAIDEN NAME), IF DIFFERENT
C, SURNAME AFTER MARRIAGE Bosch
(OPTIONAL. SEE REVERSE)
D, SOCIAL SECURITY NUMBER 087-68-8374
12 RESIDENCEA I~~TW; York B ~H-u~~ress
c, CHECK ONE [] CITY XJ TOWN 0 VILLAGE
AND
SPECIFY Wappinger
D, STREET ADDRESS 68 Easter Rd. ZIP 12512
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A, AGE 25 13,B.DATEOFBIRTH Feb. /18
MONTH DAY
YES ~ NO
/1975
YEAR
14, EMPLOYMENT
A, USUAL OCCUPATION Regis ter Nurse
B, TYPE OF INDUSTRY OR BUSINESS Putnam Hospital
15. PLACE OF BIRTH Smithtown New York
(CITY, STATE-COUNTRY IF NOT USA)
16. FATHER
A, NAME
John
P. Morrisroe
USA
B, COUNTRY OF BIRTH
17, MOTHER
A, MAIDEN NAME Maryann McBride
8. COUNTRY OF BIRTH USA
lB. NUMBER OF THIS MARRIAGE Firs t
19, PREVIOUS MARRIAGES
A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B, HOW DID LAST MARRIAGE END? (3) C DIVORCE ,31 = ANNULMENT
C, DATE J.ST MARRIAGE ENDED? / /
MONTH DAY vEAR
D, ARE ANY FORMER SPOUSE(S) ALIVE? :J YES = ~O
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING :NFORMATION
DATE :;F JECREE PLACE ISSUED AGAINST WHOM
IMONTH, ClAY. VEAR) ICITY, STATE/COUNTRY. IF NOT USA I SELF SPOUSE
2 = DEAT~
[] 1ST
2ND
3RD
4TH
nd belief that the Information i provided is true and that I declare that no legal impediment eXists
) lv
21 SIGNATURE OF GROOM ~
23.
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DME June 27, 2000
by New York Domestic
25, S, SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON'
TIME MONTH
YEAR MONTH DAY YEAR
IP
11 : 40\M 06 28
PM
00 08 26 00
1 = CIVIL
28. PLACE WHERE MARRIAGE OCCURR(j A J /J I.
A, STATE NEW YORK B. COUNTY ~c...
C, LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
U env o~ 'f 'OWN 0' ~'!
SPECIFVtiA!lll;od- E r