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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
David C.
FIRST MIDDLE
~ 4TH
that tq t e best of my knowledge and hef that the Information I provided IS tru;sand that I declare that no legal Impediment eXists
estate / .~ /' I. '
~ 22 SIGNATURE OF BRIDE. j 1j..6d'(il. ( I /f\/;(' O(2t' .;
USE RRENT~AW'-i ,-
23. ~::~;T~~~DO~N~~~~RN~~Bg~~~~E e uty Clerk \", DATE Jun~15. 2000
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law Sll 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 only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT)~ Elai~ ~ Snowden
{ SEAL SIGNATURE.~OIlU. t\. U..Li,""w:!~, DATE 6/15/00 TIME YEAR MONTH DAY
MAILING ADDRESS AM
'-v-' P.O. Box 324 Wappingers Falls NY 12590 3:15 PM 00 08 14
STREET CITY'TOWN STATE ZIP
I CERTIFY THAT! SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER. V
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 Po RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED 07 2 { 00 9 C OTHER. SPECIFY
DATE JIll-Y 2/ 2.lXJO
,
J1J'i }2S;,y;>
STATE ZIP
31. WITNESS TO CEREMONY
NAME(PRINn Kf../SD/'JE L n}u/)/N
SIGNATURE hlvtilQJ 01)1 i~
COUNTY
IlU0tOV/N
DISTRICT
NUMBER
REGISTER
NUMBER
Dutchess
Wappinger
1368
93
A FULL NAME
Townsend
CURRENT SURNAME
B BIRTH NAME. :F DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER O"i4-62-4Q44
2. RESIDENCE A New York B. Du tchess
(STATE, ICOUNTY)
C CITY Ql: TOWN 0 VILLAGE
poughkee;::;ie
o STREET ADDRESS 20 Briarwood Dr.
C. CHECK ONE
AND
SPECIFY
ZIP 12601
OYES~NO
09 /1974
YEAR
W
f-
<(
f-
(J)
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE 26 38. DATE OF BIRTH May /
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Guidance Counselor
B. TYPE OF INDUSTRY OR BUSINESS Wappinger School Dis
5. PLACE OF BIRTH poughkeepsie New York
(CITY. STATE/COUNTRY IF NOT USA)
DAY
6. FATHER
A. NAME Dwight Townsend
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Mary Husted
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
DEATH
B HOW DID LAST MARRIAGE END? (3) = DIVORCE
C. DATE LAST MARRIAGE ENDED?
1.31 :=J ANNULMENT
/ /
(2);::: DEATH
YEAR
\4ONTH DAY
D. ARE ANY -OR MER SPOUSE(S) ALIVE' C YES = 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 sa
as to my right to enter into the marr
...,
21 SIGNATURE OF GROOM.
w
en
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w
o
::::i
". ""","" -=~1{ u ^., , fllt-ll '")7 "
::::::: . :~'Zl-~
MAILING ADDRESS .
2 H&l/ff;.Y .ST'R!UT mIL- Je,
STREET CITY TOWN '
30. WITNESS TO CEREMONY
TITLE
I STATE FILE NUMBER I
(THIS SPACE FOR STATE USE ONLY)
/ 1\?-~O~
L = SUPPLEMENTAL FILE -.l
11. A. FULL NAME
FROM THE BRIDE
Deborah A.
Hichak
FIRST
MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Townsend
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER 103 -6 6 - 3910
12. RESIDENCE A New York B. Dutchess
ISTATE) (COUNTY)
C. CHECK ONE ::J CITY ~ TOWN C VILLAGE
~~~CIFY Poughkeepsie
D. STREET ADDRESS 20 Briarwood Dr. ZIP 12601
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? = YES ~ NO
13A. AGE 26 13.8. DATE OF BIRTH Oct. /10 /1973
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Consumer Loan Officer
B. TYPE OF INDUSTRY OR BUSINESS Hudson Valley FeU
15. PLACE OF BIRTH Yonkers New York
ICITY. STATE;COUNTRY IF NOT USA)
16. FATHER
William Hichak Sr.
B. COUNTRY OF BIRTH USA
A. NAME
17. MOTHER
A. MAIDEN NAME Eleanor Pietschker
B. COUNTRY OF BIRTH USA
18. 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? 13) LI DIVORCE
c. DATE LAST MARRIAGE ENDED?
3) = ANNULMENT
/ /
21 -= DEAr-
"EAR
MONTH DAY
D. ARE ANY FORMER SPOUSE,S) ALIVE? = YES = 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
1ST
2ND
3RD
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON
YEAR
00
2B. PLACE WHERE MARRIAGE OCCURRED
CIVil
A. STATE NEW YORK B COUNTY D<J1CifP..SS
C. LOCATION OF CEREMONY
,CHECK ONE AND SPECIFY)
= CITY OF )i. TOWN OFC
VilLAGE OF
SPECIFY
~(}.Sf FISIiK./'-'-
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