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155 + w ~ ~tii C\l LO C\l ...... f- >- I- ~Z :;: w oct ~= C S~w u:: ~~~ u. ~u::~oct ~ ~ iiu.g t;....~ ~<(CJ w .. C!lt:;: ~ ::l cc 0 ~() is :: w f- 15>- u: ;:: cc w CJ w cc W J: ~ (J) (J) w cc o o .. it i3 w 0.. (J) a: w In ::! :J Z o z .. t- W W a: t- en w en z w 0 ::::i + Z' . ~~~ W tu~~ I- cccc- <C t-wZ (J)...J::l! 0 :JCJW ::l!C!lc5 u:: f-Z(J) i= z- ~~~ a: ttocn w Of-> 0 ..w~ l!!~", o~ z::::;~ COUNTY Dutchess CITYfTOWN Wappinger DISTRICT1368 . NUMBER REGISTER 155 NUMBER STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM Sean Paul Hathorn MIDDLE CURRENT SURNAME FIRST ~ STATE FILE NUMBER (THIS SPACE FOR STATE USE ONL Y) I L 0 SUPPLEMENTAL FILE FROM THE BRIDE Jessica Armor Griffin MIDDLE CURRENT SURNAME -.J 1 . A. FULL NAME 11. A. FULL NAME FIRST .. N B. BIRTH NAME. IF DIFFERENT B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT C. SURNAME AFTER MARRIAGE Hathorn (OPTIONAL - SEE REVERSE)115-60-6964 D. SOCIAL SECURITY NUMBER 12. RESIDENCEA.NY BDutchess (STATE) oL (COUNTY) C. CHECK ONE ~ CITY U TOWN 0 VilLAGE AND F' hk SPECIFY IS I D. STREET ADDRESS6 Yew Court: Apt F C. SURNAME AFTER MARRIAGE (OPTIONAL - SEE REVERSEU7 4-7 4-0695 D. SOCIAL SECURITY NUMBER 2. RESIDENCE A. NY B. Dutchess (ST ATE) J.... (COUNTY) C. CHECK ONE 0 CITY LJ TOWN 0 VilLAGE ~~~CIFY Wappinger D. STREET ADDRESS 50 Carroll Dr ZIP 12590 E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES"6 NO 01 / 19 /1983 DAY YEAR 3. A. AGE 27 3B. DATE OF BIRTH E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 13.A.AGE33 13B.DATEOFBIRTH 01 )[4 ZIP 12b24 DYES '6 NO ~977 YEAR MONTH MONTH DAY 4. EMPLOYMENT A. USUAL OCCUPATION Accountant B. TYPE OF INDUSTRY OR BUSINESS Accounting 5. PLACE OF BIRTH Newburgh, New York (CITY, STATE I COUNTRY IF NOT USA) 6. FATHER A. NAME Kevin Peter Hathorn B. COUNTRY OF BIRTH USA 7. MOTHER A. MAIDEN NAME Santa Zirilli B. COUNTRY OF BIRTH Ital, 8. NUMBER OF THIS MARRIAGE 9. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVil ANNULMENT o 0 14. EMPLOYMENT A. USUAL OCCUPATION Teacher B. TYPE OF INDUSTRY OR BjJJlINESS Education 15. PLACE OF BIRTH Mount KISCO, New York (CITY, STATE I COUNTRY IF NOT USA) 16. FATHER A. NAME Thomas Cronin Griffin 'B. COUNTRY OF BIRTHU S A 17. MOTHER A. MAIDEN NAME Cathy Rose McDonnell B. COUNTRY OF BIRTHU S A 18. NUMBER OF THIS MARRIAGE 1 19. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY D~ORCE CIVIL A~ULMENT DEATH o D'"dTH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE C. DATE LAST MARRIAGE ENDED? (3) 0 ANNULMENT / / (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE C. DATE LAST MARRIAGE ENDED? MONTH DAY 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 (MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE (3) 0 ANNULMENT (2) 0 DEATH / / - YEAR MONTH DAY YEAR D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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 1~ 0 0 1~ 0 0 2ND 0 0 2ND 0 0 3RD 0 0 3RD 0 0 ~ 0 0 ~ 0 0 I duly swe?lr/affirm, dep.ose and say that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists as to my right to enter Into the ma age state, . ~ 21.SIGNATUREOFGROOM~ 22.SIGNATUREOFBRIDE~ {;;'~<2-J ~ 23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ~~E CU r USE CURRENT NAME 1/10/2010 SIGNATURE OF TOWN OR CITY CLERK ~ DATE 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 ~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 only for the purpose of a second or subsequent ceremony. 24. TOWN OR CI ER 25 A SOLEMNIZATION PERIOD BEGINS n . . ~ { SEAL} ~ NAME (PRINT) YEAR DATE 11/10/2010 Is, NY 12590 01 09 2011 STREET I CERTIFY THAT I SOLEMNIZED THE MARRIAGE OF THE PER- SONS NAMED ABOVE ON THE DATE AND AT THE TIME AND PLACE INDICATED. CITYrrOWN 26. SOLEMNIZATION OCCURRED TIME MO. DAY YEAR dC1J STATE 27. TYPE OF CEREMONY o Ii{ RELIGIOUS 9 0 OTHER, SPECIFY ZIP 28. PLACE WHERE MARRIAGE OCCURREia A. STATE NEW YORK B. COUNTY vW fltY\ 10 CIVIL ).c fO PM II 29. OFFICIANT () Cv /SIC, ^ . 1 C. '? R.-EAJ ~ I A tJ NAME (PRINT) ,.... nIV . D. /''''/ ~ r~ ~# SIGNATURE~tJ...-v ~ ~~ MAILING ADDIIlESS . . ZZ/ G. t.j:)/~'i... tJt..,;' J /11 ~/-fdP,4C- STREET CITYrrowN 30. WITNESS TO CEREMONY NAME (PRINT) In 4?JcJc-r- C. LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) TITLE K. G fl?., f. 5/ DATE II /)..e)/~1/() AJi l~j",,1 STATE ZIP 31, WITNESS TO CEREMONY NAME (PRINT) '\:Xx \ $ G:, v .(.. o CITY OF tL. SPECIFY SIGNATURE~ DOH-98 (09/2009) SIGNATURE~