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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
John David Sharp
MIDDLE CURRENT SURNAME
UN Dutchess
co "TY
CI"TYfTOW wappinger
DISTRICT ~6~ '
NUMBER
REGISTER 1 01
NUMBER
1 , A, FULL NAME
FIRST
Q.
N
B, BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)464_67 -5310
0, SOCIAL SECURITY NUMBER
2, RESIDENCE A. Iowa B. Johnson
(ST~) (COUNlY)
C. CHECK ONE CI"TY 0 TOWN 0 VILLAGE
AND I 't
SPECIFY owa I y
D. STREET ADDRESS 2660 I nple (.;rown Lane: 1Fozlp 0224U
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? cJ YES 0 NO
01 /03 /1978
OA Y YEAR
3. A. AGE 32
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Student
B, "TYPE OF INDUER~ OR ElU~INE~ U. Iowa
5. PLACE OF BIRTH 0 umo!a, Issoun
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME John Malcolm Sharp
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Carol Eva Martin
B. COUNTRY OF BIRTH USA
1
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV<crCE CIVIL AN~ULMENT
DEOTH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C, DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
YEAR
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Tara Sue Leonard
~
11. A. FULL NAME
FIRST
MIDOLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Sharp
(OPTIONAL - SEE REVERSE)1 09-60-2006
0, SOCIAL SEpURITY NUMBER
12. RESIDENCE A.lowa B, Johnson
(ST~) (COUNTY)
C. CHECK O~E . CITY 0 TOWN 0 VILLAGE
~~~CIFY Iowa Ity
~o6::> I nple Crown Lane: #::> 52240
D. STREET ADDRESS z.:;
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIlLAGE? 0 YE~M5NO
13. A, AGE 35 13B.DATE OF BIRTH 03 ))6 ~
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Cook
B. TYPE OF IND~rY Pl3 BUSIN;q; Hestaurant
15. PLACE OF BIRTH .. KISCO, ew YorK
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Michael Joseph Leonard
'B. COUNTRY OF BIRTHU ::i A
17. MOTHER .
A. MAIDEN NAME Karen Lynn Cartaleml
B. COUNTRY OF BIRTHU ::i ~
1B. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL A~ULMENT
.,
B. HOW DID LAST MARRIAGE END? (3) 0 DIVO~E1 (3) ~NULMENT 1 g~~ DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTIIjII' DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
w~~w,.pI\1.:tFM) P (CITY/\C.DJ.!NTY, STATElCOfiRY, IF NOT USA) SELF SPO~E
1ST U IL':JII':J':J/j ougnKeepsle,l'IY 0 0
D1jTH
o 0
o 0 2ND
o 0 3RD
o 0 4TH
dge and belief that the information I provided is tru
w
en
z
w
o
:::i
This license authorizes the marriage in New York State of the bride and groom named above y ny person authorized
Relations Law ~11 to perform marriage ceremonies within New York State. THiS LICENSE VALID IN NEW YO K STATE ONLY.
o If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CI:l'o'hW'b. Ma 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
~
{ SEAL }
'-v-I
25, B. SOLEMNIZATION PERIOO
ENDS AT MIDNIGHT ON:
10/28/201 0
DATE
sh Rd, Wappingers Falls, NY 12590
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
YEAR
MONTH
DAY
YEAR
12
27 2010
STATE
27. "TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER. SPECIFY
\0
ZIP
1~CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY Pt..ttnC\~
~"
TITLE If \\ teR
DATE 0 30/10
,
NY
STATE
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~ VILLAGE OF
SPECIFY c-,\ d Sp4''lj
29. OFFICIANT
NAME (PRINT)
SIGNATURE ~
MAllI~G ADORES " I \J
...tb W ~ Sf Ad 3C )\JfuJ f0/k
STREET I P CITYfTOWN
30. WITNESS TO CEREjONY
NAME (PRINT) I. \ o't.-
SIGNATURE~
DOH-98 (09/2009)
100d5
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) IN l't l\. ~ ~, ""
./'7> -j ~ ~
SIGNATURE~ ' A/"~