2010
.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Col!)' of Marriage Record
__:~?;,~.(:: '.:: ;."'0";'~::;::;~>>;"<<""""l""::i;''''''':<'Y=''''''''''''~'''''~''' . ,....^...~/..,v'..^".A."'W..-:...:~..""'r1QJm'.."~:;::,~{8<,".""@__
~~~;.').~::::.t~..:-.::t::::.:::.::.:tmU:.>>....< ID. .~ ^J. ~{ <::.1 f.: ~ ~ '''~ <<... ~> ; $ ~,:: ;." t -' ~ ".: : ~. ,:ycj::" 'X-"x)"; <:;'" "'-::=Y:"':::::}:~:~1x>>">'~':ffi
.:-:.;....... ...,....x.:.:<...{'~~:::: ."...1<^....~-... .. ....':1-.6..... ..v..v...."v. . ...., A""' ,~-: ....~.. ..:.-'"_-v."<.-..~..'..NV) ..::-::<<.;::=.::':-::::::.:2..~:::.<s...-:.s.~:..::
x<<,:,,--=,,';:';"~"y"'~. :<<. .'V'N'...... './'".':-':"" ...-...-'".-............. v .".', ..... ..... . ...... ........;..<.y^ .....;.:::............. ..;.:.:......v...~;..W":'~;.m
Search and D
Certification Fee $10.00
per copy
A Certification. an abstract from the marriage record issued
under the seal of the Health Department. includes the names of
the contracting parties, their residence at the tima the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee$10.oo
per copy
A Certified Transcript includes aR of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports. veteran's benefits, court
proceedings, or settlement of an estate.
-w.' l(:"'~' '~%i. .."" ,< . '''~~' " V'=''' "'"0" t"'f.'y: N, "~".'<""4' 'W' . v;- . "''''''''i,l''"''ii'* 'V''''v', ~"",#."... . '~0'~'"'<<<li}_
{~$ridl?J1}0\~~f~4: <:~~~~ ~~::::~ ~~~L i~;~f: ;&~~i ::.~: .L \.~~~ :;. ~ ~~ ~': 1~:;;;. ~ f .~~~~ ~/~~~ ~ ~~~>.~ ~~:;*~ i.~.t~I\iL::: ~ .~;. ~~~ ~~~~ ;t?1.~ ~~<kf~ti&MiI*^
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
:ride ./)U ~~
If Bride Previously
"c-- 0 (t Married, State Name J ~ ft /~
v .J 0 Used at That Time V t.. VVL
r_ II Place Where . (I J.1 ~/c5fts s:
er)~J Iv ~was w;{f;k,.. 7Jfvp
(Middle)
(Last)
&/tI-el~o
If?()
(State)
IV
6
t3
(State)
;V
For wh~rpose is information required? What is your relationship to person whose record is requested?
f4j~~ ~r~s"''''--'. Se/;::
In what capacity are you acting?
e('S
If attorney: N8T18 and relationship of your client to persons
whose marriage record is r~
/
..
])~ ;;..a.~ ~()
Please print name and address where record is to be sent
L)
(PLEASE SEE REVERSE SIDE)
/JG- dOCJ~
,>
~
s
-
NEW YORK STATE DEPARTMENT OF HEALTH
Vita! Records Section
Application to Town/City Clerk
for COe)' of Marriage Record
Se~chand D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting ~es, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle)
of (C' .
Groom hI', J,)
Groom's Age
or Date of
Birth
Residence (State)
of \""\
Groom \J t.\, t- c..l. e..
Date of Marriage
or Period Covered \""' (l J
b Search 0\..\,~L' ) trOD ~
Place Where [J
Ucense Was 0.-
Issued
For what purpose is information required?
-pC1 ~~pOn-
In what capacity ~e you acting?
Name (First) (Last)
of "l"'\
Bride Ue./"\IS .e....
Bride's Age
~~ateof S'e i. )..8//17"
Residence (County)
~fride '0 "':+ cJ e S S
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
\Nhat is your rela~ip to;rson whose record is requested?
If self. state -setf.- ::i~/
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
l .tl;.~0
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
N33D1IZGI09
1F~6
~ - 9- 06
s
..
c'
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriage Record
Se~chand D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting ~es, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
rvl" Fee $10.00
L,Ci per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
~entage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name ~t) (Last)
of ~0J ,c:, A. LJ(~ of -:::jo~N If ()flc ((C
Groom IL Bride
Groom's Age ~q Bride's Age
or Date of or Date of "=If
Birth Birth
Residence (County) (S~) i Residence (State)
of l)V(crh:(~ of N
Groom Bride
Date of Marriage If Bride Previously
or Period Covered '6 0'1 ((39 Married, State Name ,...--
~
b Search Used at That Time
Place Where Place Where ^,
Ucense Was Marriage Was
Issued Performed
For what ~ is information required?
i l U 0 v\.C r
In what capacity are you acting?
, ~avF
Vllhat is your relationship to person whose record is requested?
If self, state -self.-
~FL ~-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
d--S ; ()
~ l\'iI
~-->-rt\-, ~
, h-\' ~cr (L~q 0
DOH-301 (3/93)
12 10
Please print name and address e record is to be sent
L, Lv C~c..)
d-S"2.,o ~. I\v~
W IT{> P 0.-<: I'--- (2 ccr 0
(PLEASE SEE REVERSE SIDE)
.
,~.,._.:",~-.-~ ,~. - ._~
.....~""'.'...'..z. (.
O~\.'. l
I....'...tr!........... ........ ..~i...
'~f!~tl1 j
.......11........,. ....~............~~............. ..
"f'~
c'. <c' f..,.'JI"
"r...I..~'~{./~:1...0'"""t
.. .it~...;<-.~.~......~.:...i..;~............~... . '~i;
,,;~::......... ..' 1
00 ~;;,.., .'. i
>. -.", .~.c_ . . ,
~. ...
."'.'11':. . ....".. .
.'5VJ
H
..
.
C).:.)
...........
~
()
~
-
\:
it~
CV
eN
-.\::)
r.
I .
L..---"'
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
3. r71' Fee $10.00
...u per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
>~~;=w<.,x<<.." NN. , .M....'. "'. .'. M... . .~, . ..., ~. ,..w,..' .,. .~. .~.. . ,,> . ,.. ~'. . ..' ".. d N""" "=11>>'>>;- '" '''3;;ill.",,_
::."X :z;::;.::.;:.......OX"x..;...v...........:--:. .. ....;,:,......'.,.0..........'-. .~.....,x.... ......."............'-'^'-'........... ............v,.. . ..~.. ... :..". .... .. .;-:..........,.y.........t, ....~ ;.u........ x~:; x:.:.:../.....~;;v... :::;::,-::~:":>
tt wji@~6t{f:t;tXi~1iJ.Li::.:.L;> L::\.~:~>;::., . ,,:4. t .,' L\.: ;.,'~. '/~ ;,.>...::;,,} ~ .}; .<.. ,::w. :<"~.:><'J../.::;:.::~ ;gwtt ":illi1t'iiteG
(Last)
rl
(State)
N.y
For what purpose is information required?
In what capacity are you acting?
(First)
(Middle)
(Last)
,."
Name
of
Bride
Bride's Age
or Date of .
Birth ~
Residence
of
Bride
If Bride Previously
Married. State Name
Used at That Time
Place Where
Marriage Was
Performed
.
,"
.J'l.
&l /1'..1-'
(County)
(State)
AI.
\/\/hat is your relationship to person whose record is requested?
If self. state "self..
If attorney: Name and relationship of your client to persons
whose marriage record is required.
.
"'
Address of Applicant
/sl-/O FI-."ltllll A~ # 11"1
~~4#." M.71Ilt-t
DOH-301 (3/93)
(PLEASE SEE REVERSE IDE)
DEe 0 8 2010
TOWN OF WAPPINGER
TOWN CLERK
..
.
Where to Apply for Record of Marriage
1. License Issued in New York State (Outside of New York City)
Year of Marriage
Apply to:
* 1880 to present
Certification Unit
Vital Records Section
P.O. Box 2602
Albany, NY 12220-2602
* 1880 - 1907 and license issued
in the cities of Albany, Buffalo
or Yonkers
Albany: City Clerk, City Hall,
Albany, NY 12207
Buffalo: City Clerk, City Hall,
Buffalo, NY 14202
Yonkers: City Clerk
City Hall
Yonkers, NY 10701
2. License Issued in New York City
Apply to the Borough office of the New York City Clerk that issued the marriage license.
The location of these offices follows:
Manhattan - Municipal Building, New York, NY 10007
Brooklyn - Municipal Building, Brooklyn, NY 11202
Bronx - (Records for 1908-1913 are on file with the Manhattan office)
1780 Grand Concourse, New York, NY 10457
Queens - (Records prior to 1898 are on file with the New York State Department of
Health) 120-55 Queens Boulevard, Kew Gardens, Jamaica, NY 11424
Richmond - (Records prior to 1898 are on file with the New York State Department of
Health) Borough Hall, St. George. Staten Island, NY 10301.
PLEASE NOTE: Records of marriages in areas of the present City of New York, which
were not part of the city at the time of marriage, are on file with the
State Department of Health.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CoeY of Marria~e Record
Search and
Certification
r\7I Fee $10.00
~ per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department. includes the names of
the contracting parties. their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports. veteran's benefits. court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of J Cf ~
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was 1 lOt
Issued VV
(Middle)
L()d~
(last)
G=:lJ Z (Y)C\ "
'tJ'5/13
(County)
(State)
fJl
S
/Djq/'Q
For what purpose is information required?
(' f-or"lc.e Or: NOme
v
In what capacity are you acting?
(Middle)
8os~
/ //2) f L/
(Last)
LJ 1.4.ed .c 0
Name (First)
of J
Bride " DanntA
Bride's Age
or Date of
Birth
Residence (County)
:ride DJ+ch:ss
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was I j
Performed tl1
(State)
!J
What is your relationship to person whose record is requested?
If self, state -self.-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date
jJ! fit/I 0
Please print name and address where record is to be sent
-:!J
(PLEAS SEE REVERSE SIDE)
DEe 0 8 2010
TOWN OF WAPPINGER
TOWN CLERK
DOH-301 (3/93)
..
.
~~.. '--
C>
~ \
--D
,
.......
~ C::>
\l?~fi:\~.riki:~,.~;i<( . ,~,.~:.{;.,;;,. ".. : . . ":;.,.. <. ,'^,~::";'':'. :;" z..~..l:.f\:\~..;
..;w::;,,$'<~$"'> ~^,,"~m '.<< . . '".", .", ,,'.N)1::.. , . . ..: '" . ,. ",...., ," . . .",x.,"",.::::i:$~
Nel'N YORK STATE DEPARTMENT OF HEALTH
V~ Records Section
Search and
Certification
D Fee$10.00
per copy
A Certification, an absIract from the marriage reGOrd issued
under the seal of the Health Department. includes the names of
the contracting parties, their residence at "'Iime the license
was issued as well as date and place of birth of the bride .-
groom.
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Col!)' of Marriage Record
rl Fee$10.00
~ per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
SeIRh and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other ~ may be
requi'ed such as: passpor1B, 's , court
proceedings, or settlement of., .
..... ..-".....~,<-^ ...~:~. ......,... . b .. '" '''-"" , ....... _ d
.., '''''''':':<<'0 .,..-ox.:.0............ ' . . . ..,' "".,=>:, -.,' """':::i
"Li;.f~.,<;;{:.m~!<::.~,... . , ..~ d" .: . ..' . .' ,'C .~} r .': '. , x .~~!w.::': ,J
PLEASE PRINT OR TYPE
Name (First)
:room /2o&e
Groom's Age
or Date of
Bir1h
Residence
of
Groom
Date of Marriage
or Period Covered
Search
Place Where
Ucense Was
Issued
(Middle)
~
.51
(Last)
/J1(?1h4!J I ro
(County)
uLsrEI2
(State)
O?/ ~o I
wA'7/,q,1/~ .F-/l-~
eel t1 ;r./ t+; () ~ OC( t+lf7,rS
(Middle)
(Last)
;.2a rL/f;VI~
Name (Fnt)
:ride cJ I?M IUC
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
='=r::- ;:)/ltV;;V~ L ~r~1)
Place Where . U.l~~,vc-~Hu.- S
~:Was CoUA.lrz1 OF Dt4a;~S;S
L
S'I
(County)
OWQ-/~ .
(State)
Nlf'
~J:..:,:'........\...; ~:':'>.." ..' ",,' , . . ," ' \.~'.; .",:'.:'
For what purpose IS information required?
verG:;U::}I'<S Ai//'J1 (jV (~r /O;J
( VA-)
What. your relationship to person whose record IS requested?
If self, state "seIf.- sat:.
;~:J~~1;;};~~::%~~<)~:if.t?/~.. .~>.: ::.' ." .' ~":~' ' . . .' J". ~:.;;:, :,,' . . '. .'... ,'. /.. ".';:,~
(PLEASE SEE REVERSE SIDE)
ROSARIA PEPLOW
Notary Public, state of N~J~ll5e896
\11lalified to Ulster County, Reg. #27 20 J!/
. CommisSion Expires Jan. ~
In what capacity are you acting?
:5aF
Signature of Applicant
~ fZ.~~
Address of Applicant
7:3 /'JOan; i2-b fJOI g I
M \ G-H L-A-fJD) f'J 'I J 2.-S-;>,,8'
"L/
If atIDr'rlet. Name and reIationstip of your client to pet'8On&
whose marriage record is required.
Da1e
I':). 177 /0
Please print name and address where record is to be sent
;<o8€12..r /2.., J1'JotlAB ilO '.
7? (uol<rH,eD p,-fJr. B
H / G:H t,.-A'f'/P' ALf' ) 2rc5" .:J.,3.
-_....,--.'"",...~ .,.,.- ,..,"--'~,
'-
)f .
I
"
\.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
~
Application to Town;
for Coey of Marriar..
tWJttf~i;;~$ljf.N::~~: ,/ '~.. ~,':
,,~~'"'' .}kfliillRh., }'>, ,. . . '. .... :..
Search and
Certification
DFee$10.00
pw copr
A. Cet1ific:ation. an 8bsnct from the ~ record iI8ued
under the seeI of the HeaIIh eep.tmeItt. includes .. ranes of
the contracting parties. their reeidela at the time ..license
was issued as well as d8Ie Md place of l*Il 0I1he bride Md
groom.
A Certification may be used as prooIlhat a mell. occured.
s-dlMd D
C8rIiIi8d Copy Fee
perc
A CertiIed T..~ipl includes aI 0I1he iIems of inb
occuring on .. original record of Ihe marriage.
A Certified TfWlSClipl may be needed where proof of
plnltIagD Md certain oIt& details d intormaIion may be
requRd such as: ~ (] S sports. ~.. benefiI&. ccut
proceecInga. or u.aa_1t ohm esIaIe.
~~1$};~:~::~~:f~:"'..'>> ,. , "'''<?::,~. :"~':~~;~;::~!il~}iB..
(Middle)
(u.t)
Macore lr
'n~rareYC~Hdng?
D0H-301 (3/99)
NIne (FinIf)
:. A '
Bride's Age
or Dale 01
Bir1h
AlIside4k;8
of
Bride
If Bride PnMousIy
Married. State Name
UIed at That TIII'l8
PIIIce wtBe
...... Was
Pefb.*
(Last)
-
rQ
.r ~lf
If aIIDrney. ......xI relBlliDnllhip of}'OW client to persons
wholIe nl8l'ri8ge record is rec:p.ed.
is to be sent
,.
it
.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CollY of Marriage Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
_~m::::::::w:::~n:"'f,v"'<"X:":;'x"'''':B"Y;'''''Nf'~:>/''~'';':~'''':'' ;.....:f..;...^--::..'-~ .-;-...... .:~~~ y,:' .... ... -..: ~ :-...y.:'>.."}; ,....<<."'=:8:::>>.....:.:-::...;.........:. >'X~"""'{.":'-:::y'lj.:::;' ..<...^~mW~~~~1
:~mtU!iti~If~Ji%i..?t;~<::.;~..}. .L:J<..;~~~~.. .:~;~ ~...<~~ X .~~; ~~ ~. .:. ~'~.: );~t~..~.;.:dt;;~;......;:NJ~..~:...~~L...::~..;~~~/~jt~iktmA~V41&~
PLEASE PRINT OR TYPE
Name ( First) (Middle) (Last) Name (First)
of of
Groom ~~ . Bride
Groom's Age Bride's Age
or Date of I'DJZ or Date of
Birth Birth
Aesidence (County) (State) Residence
of of \.VIA
Groom l0 Bride
Date of Marriage If Bride Previously
or Period Covered I Dl Married, State Name
b Search 10 Used at That Time
Place Where \tdt Place Where
Ucense Was Marriage Was
Issued Performed
(Middle) (Last)
y
(State)
~
For what purpose is information required?
( ~""-7L <'>~~ (' &\.-1'1 ~
d.~'1 v <: Y ~ L\ f---e Y"- y...
In what capacity are you acting?
V\Ihat is your relationship to person whose record is requested?
If self, state -self.-
Sel+
If attorney: Name and relationship of your client to persons
whose marriage record is required.
iI~:w...u'~_~<0.""?;r:<<C:::::-;:?:%..."".>;;.:<<'t"'m:;.">'<':.>"ir"". :~., . " ". ".' . . .. '.. ',.. ,....,' ,. . '. .......,.., "'".'/0 :. ^<.;,'~;:;:,<;:2;:'1~';lv"':;:;=>:s>""ffl{V'w;::%1I
W<::m m:l@:'~t~~ (h~.;:1;Jif.4.~~~si/*f~.;;~:~.::::.~~r{(: };<;: ~~ ~. ~ ~ ".~ ""'" .. J t~.. ~~~':~t.." ":::: ," ~~): . '~~', .~...~ ~ ~ <.: ~~.~~ ]..{. &~~{~\~ttLtFPJ(~UM~&*"%
wm;.;.$.: .. w~:::.M.::: ,,~>,'::::~>>::.::;...~..>>:::;~.........:'JX:>~:::n...>>...*x~.....--=.....-<<<...t.>>.. <;'. x .:' . . ..<...::. .;...$.~>.. .... ./....:......-:....>.-:::....t:s~.......y<<<..~/.~>>~~~.:t:::~M;:;:&.-<<z(&:.-.:::.>>:
s~~t_
Address of Applicant
I'S~ W~~-k ~~ Y<J
~i~:S -4.\ \51 ~'I 12510
Date
\\/~/,o
Please print name and address where record is to be sent
&rctt'\.tL' ,A-h.'^r.i~)ID (cx:t\iRS)
l"Sh ~~'\ ~ J~ I<J.
lOa. e',,, -<.rs ~ '\5, \0~ I? 57D
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
...
.
..
j'
;/
..
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriaqe Record
D Fee$10.oo
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
fi:,-::"<-~~~r.~m;'jo",::"jo"-:>>,,:jo"..;...~^:t:.:,::.: <::-#~:,y&X:<<"0(~"*'~">>~~>:%~~"::""-;>><x::(':'~% ~',,-' >> :. ..;." ~<::.~<<..X~~." ...<..:;..;:<.....<<.$9w....v..:::........ ..:-..~~"'X9ll:m.:.)~..<)):mx:&.~...WWtJ
fH&tW4W0ill*MThgf~1$j};;1;ti~fJ.!il;;;L~li2;;i~~dit~t!t:{<Z' ~:JL:.f;;~~J~!.t~J/L~,~Lkd;2]ktiii;;_llikia:7&$h1b 8WM
PLEASE PRINT OR lYPE
Name (First)
of I.
Groom L..LJ \.(~
Groom's Age
or Date of
Birth
Residence (County)
~room b0\e~
Date of Marriage
or Period Covered l 0 _ 0 c.... "\ I'A
b Search - \ - 000-.
P.lace Where WrJ)() Mill" ''OW R \-\tLJ J
Ucense Was -r r ~ . -8' /t
Issued \JJ \ S t-J
(Last)
lvta
\J--\\-\[1<<0
(Middle)
\s
(State)
N'I
For what purpose is information required?
1'1)j~ ~~
(Last)
Ib~s
0\ - d tt - l q ~'d--
(County) (State)
"t-J '-I
(First)
(Middle)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of '1'--..'
Bride \--.) u\-c b .es,:s
If Bride Previously
Married, State Name ~~
Used at That Time ...
P~ Where U.kUJp MrU r'16&AY'\
MamageWas - 1 . - Q-
Performed W .
\Nhat is your relationship to person whose record is requested?
If self. state -self.- .
If attorney: Name and relationship of your client to persons
whose marriage record is required.
~
(PLEASE SEE REVERSE SIDE)
/-
;'
NE~~K STATE
DRIVER LICENSE
10: 731 287 619 CLASS 0
ALaUS
ANDREA,L
6603 CHELSEA CV N
HOPEWELL JNCT NY 12533
DaB: 01-29-82
SEX: F EYES: BR HT: 5-06
E NONE
/' L" . /~.A R NONE
.r~~-"<::7 ISSUED: 08-04-09 EXPIRES 01.29.12 VDFHGDKR13
~c
PATRICK C. CUNNI
Notary Public - State of New York
No.02CU6070849
Qu.'~ ~ Westchester County
My ComlTllsslOn Expires Mar. 11, 2014
/)
0-/00 'i -
}Ii
October 29th, 2010
Town of Wappinger
Town Clerk's Office
20 Middlebush Rd.
Wappingers Falls, NY 12590
To Whom It May Concern:
I, Andrea Albus, would like to request THREE (3) Certified Copies of my Marriage
License so I may change my last name with the necessary agencies and companies.
Enclosed is payment in the amount of $30.00, Check # 0976.
Thank you.
Sincerely,
\~c
PATRICK C. CUNNI
Notary Public - State of ew York
No. 02CU6070849
Qualifted in Westchester County
My Commission Expires Mar. 11,2014
r~
Ct NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of MarriaQe Record
.
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record Issued
under the seal of the Heallh Departmenl. includes the names of
the contracting parties, their residence at the time the license
was issued es welles date and place of birth of the bride and
groom.
A Certification may be used 88, proof that a marriage occurred.
M Fee$10.00
~ per copy
A Certified Transcript Includes all of the items of Information
occurring on !he original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed Information may be
required such 88: passports; veteran's benefits. court
proceedings. or settlement of an eelate.
t:;~~~;~;~:!;:l:.~~ff;~~1:< ~ r::,,~,'~.:: ~j,;;~;~;\ /~~ ?;~r; ,\'I/X.:',T:t\ ':, ,;':i "~f)' :~,; (t, t,') Ei{T ~:. ii: ; ,~J}:{~:5~~~~l\s:~::~~t:~;~;tn~1IOI:JJj
PLEASE PRINT OR TYPE
Name (First) (Middle) (L.8st)
. :room GIO(/-'f;Y/>JI .FI~,elro
Groom~Age ,~
or Date of / .I)1'/il-r!.- W ';?3,eJ; IC/ 36
Birth M. C?T,
Residence (County~ SS lL I C-- (State)
of' l" fl
.Groom 4- Te{{SO u JJ t, oc/ )~ S l'f
Date of Marriege A ,-
or Period Covered .-r;;N C / I / 9 ~ ~
b Search ""d U (.C.- I
Place Where
~=W88 11/IlPI&/Gfi~ MU~ ~
For w!l~rpose is Information required?
IeOClF Or J(II;e.~//'l~E
In What capacity are you acdng?
F K - ~ fJrJIL.S e
Name (First) (Middle) (last)
~~de AN7CJNIGrl7f /!tJ7),NSD
Bride's Age Yl
:~ateof r!'J(!,708EA1 J?7- /98
Residence (County) (State)
:ride ])JTC- ~ ~ I ~"E- W 'toa. K
If Bride Previously ~
Married, Slate Name
Used at That Time
Place Where S-r. Hntf'v/s &IIt/1G (!-~ ell/I L
~=:::~ It/IIIi/EN6G,fS HiLLS/ /V.y. /:t5~ ,
Wha' is your relationship to person whose record Is requested?
If self. state -self! $c t-F
If attorney: Name and relationship of your client to persons
whose marriage recor<l is required.
Signature of Applicant _ ~
C!Jr-y ~~ ,.-'" rr-t-..:..-X tV
ddr;Ar;~r(3LLI dg-iLEOJrf9;
C/7/0eJ K.46.I5.'/I- tr1J1'-YJ
DOH-301 (3/9G)
ovTbB~'<. Ab+1.. t .20.19
Please print name and address where record Is to be sent.
GIOtl/lNN/ hlfleltO ;()a
VI f.l ,t:2,crrELL-i e() NK 7
tj1/()o lit ~ Cj
(PLEASE SEE REVERSE SIDE)
Tuesday, October 19,2010
Enclosed please find the following documents on behalf of a request for
a copy of the Marriage License for Mr. Giovanni Firrito.
. Application to Town Clerk for copy of Marriage record.
. Written request translated, signed and notarized for signature
. Copy of Mr. Firrito's drivers license
. Check for $10.00 made out to Town ofWappenger
. Return envelop with address to send document
Mr. Firrito address for the mailing:
Giovanni Firrito
Via Fratelli Belleo n. 89
97100 Ragusa Italia
We spoke to Chris Masterson today concerning this request, the
situation and confirmed articles to forward at 845-297-5771.
Thank you in advance for your assistance.
-
#/If" '
Via Fratelli Belleo 89
97100 Ragusa, Italia
Town Hall
20 Middlebush, Rd.
Wappengers Falls New York 12590
CIA: Segretario comunale
......-'.
: II \~ottoscritto Giovanni Firrito, nato a Ragusa, Italia, il 23 marzo 1935, residente
:a}l'"irdirizzo sopra riportato,
/. "
'>.,e
..../
CHIEDE
di poter ricevere una copia del suo certificato di matrimonio. Si richiede copia come prova
del matrimonio con Antonietta Alfonso allo scopo di ottenere il suo certificato di morte che
e necessario per un nuovo matrimonio religioso.
c/- ~ ~ Con osservanza,
/~ O)~t~~~
Vera ed autentica la superiore firma apposta alia mia presenza e vista da
Firrito Giovanni, nato a Ragusa il 23 marzo 1935 ed ivi domiciliato in
via Fratelli Belleo n. 89, della cui identita personale io notaio sono certa.
Ragusa, 11 ottobre 2010
1-
I:
,
if.: ... -
If 1:1
2.f-
;; .-
~..' i-
i'
._...._~:'........"._.....__...._.._......
-Data ':"'h'~"_'_'_h_"_";""",_,
. Arm! . ..............;............._____...................
! C; IJ.l(Hf~b-~;1 ~
klt~tCln ~[R rSAHl
um Provo dl
(It.
f17/()6- O!>/lIf''.-10/QcUa:H
.' ~ .l' Y".?> it '~lj"\n'l
. ~ .. ~:1: -.; :>':" y. ..t'. "t...
-~"~""'~I""${.J','~'~.~~..~~~~~... .
. . ~ '''::, <~'l.jv;,<" .~..",' i,. ". ~1-.M. f.~'i~", ~.
',' .'1 \~~,,<\~~~J~::;~ ,:~:.:"ft;:~!~~::t:~,~~F.:.", ~
-;.:....~:. .L,~~tr:t.~J.t.?.':' r<"7..<~f:.
PATENTE N. BG201J177L (K~ZVJM)
VALItlA FINO AL 06/1.1/2011
'NESSUNA PREsCRIZIONE
(tll;~~~~~~~ ...
. .
. .....'! r........~.~. .....,. ~ .'!~....;~. ....... ."~.:' ~......... .........:... ...:.... .....:~ ~I'.~..'''':~. ~~ .
" ":
-...... ...'....: ......_--.,-.....~ ,....... -....;......... ..........":~.'":..:".'!t.~..... ":t'.~
. - .
'. .
--.-................... ......._.._...r.:...;;..~.T:~.'7:r~.~...T.:
...:....... ...~.. ...,,=~~~..:;.~~.~:"..~!::';;.~..~...~:.t.'~.~~'*7;:~~:'
_............,................ ......,...-...~...........-............':....... ._......_._~-..._---':'................. .
~OTE: ..~,\::'~.\;~;~::</H: .>~;,?\.;<) ,: ;~f~.~:~~/ :~
th~~j.jt: ~ ~!...i~~~: rj~io" ~'~.erQ (Iina' a 7.5.' ri.ii a :
'/ 'R~n9: 'iM:1cj>~. ~ .' >' ".;" .
';'m~ a'ijChl!....'t'.:al~fe:riMori:lilo.nbllleirie'" :CQ~ Pl!S~ a p;eno
. ". _-taricli, !l9!' ~~~~~<; .!l ~,o .a .~'!'?.w.:"41~h1of~lce e t.1e
'../ :~hl!i II:Pe~ '.Picnq w";ll:del ~ )Ie'/J;Q!t:(IQn'Jupj:'" I ~5 q.lI,
(3) f....p.ten~ dl <.oteloria 8 abili '~ a~...II. ~\Jt~. do mac-
chine -Irlcolc; cal'"relJl e m...cchu....'"Pper.~~J:..,
(4) "1..- iuld;a del.rit9to.,.ic()Ii.~ "~,o-veicoli. '~f 'c~f~rcomma ,.
de/l"MI.,Z dello. L. H.2-7i ~"m..t.2 ~ su~dl/l;lta ad 'po
'.. -" ~~7,i~~'~:f~:':: '.:I}
;.::~~:.~-~~~~~~~~';i:~~,~J.~:.
i~(YElcoi:l:rE~.f~tl^ it:lAPA'fir-ir( ~ - vAfi o~:i}
{~S:i~if,~;9r;m;.i:!f!:i;};)f~ e
o
.7L-;;;:</..
..... .< ~ . ',' ( ..._.. ."........
';<'.) '~::.~.:.~:::.:::. . ,,-..; ""'; ',.. .'. ':, ";,:; .>; :;<""~:'
:;.. RE P U Ba LI CA>~ftA~' IANA'.'::';' ,:.\.
.;' .. '.. ;:.:.,::,..:~. ....'; ......2;; >'~..~.0::;;<:"<.:.:>.:.
'. MYN',frERC{:; l5'e.j ::rk"AS~PORl;'
. OIRSl1;ihNI' t;I'~E1J.& '6E(J.':Mbio~:IZzAzIONii:
. CIVI~~ !: ilEl,.1ll"SPQ.RTU.N.:<;?Nc;e~.$~.O~I'
:.:.:::. ::.:'.:~:::.~:., ;::';.' .'
'.1
'. c
:0
o
..
'"
.... "~
'<
Z
il
!f
~ .: 0
oi
...
~
. .
'; :"'::':;;':,:' G:'>"'Dj;~
p ATE NJ:.f,),J.?..;:,~....U;.
........ '. '; :.'~:.::;;W{<:~.:(.~':W::>).~ .
..... .
PERMis.D.fCONDUIRE
,", .:.",.~ t ,"',.?~ .~::,~',~; (J . -',
f ~.~::;~. '~'"
',(
"
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriaqe Record
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the lime the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits. court
proceedings, or set1lement of an estate.
_>}.'!'.I'.N'."'.........--..........N ....n.....-........... ~,-,v.'...I'. ......... .....-"'...... ...^o..,Y... .. "'~' ,r.....,...........'-. ......'..I'.N....N.. ..........<'-""'_.:-........wm_i
?:Br. :;:;...........}..~<:;...............'Y'.>...............",.-:.........."\N..V.....I'. ......... ............'..... -. .. ......... ~.' .. . "\....x.. .... .;.""....... ........... . ^...-^9.."^...~.... ...... x"'>>'V .
?- %%.~#/t&f;}EbiN10:'>J~;;><;.;.;;::>L";<<;;,;:', ~ < :~:,.;' ..' .~~.' .:;. '. ~~> >.,::;..&:. ~~,..::i.L:~~~ ".<...:..,J);;;;{;;;;:1;).@; . ZWdd jj;
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last)
~room Ii fk D S /01()tJE
Groom's Age :-1.-
~~ateof Z~ -03- ~T
Residence (County) (State)
~room --=rTJtL"
Date of Marriage
~~=hCovered 10- -I 0
Place Where
Ucense Was ~ I W ~PIIO&m 'f?AA1 A <:
Issued T{jJJ(lJ r I , '\..A- r 'r I , I~
For what purpose is information required?
In what capacity are you acting?
Name (First) (Middle) -(last)
of ~.A. ./I ,/)()
Bride 1J..ll LA.Jb' Q U
Bride~A~ q
:~ateof q ~ Z- 4- 1-
Residence (County) (State)
of
Bride r
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was .
Performed
VVhat is your relationship to person whose record is requested?
If self, state -self.- "
If attorney: Name and relationship of your client to persons
whose marriage record is required.
S~
Address of Applicant
DOH-301 (3/93)
/ 0 -I) -( ()
Please print name and address where record is to be senL
(PLEASE SEE REVERSE SIDE)
~-
.'
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriage Record
Se~chand D
Certification Fee $10.00
per copy
A Certification, an abstract from the m~riage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
l"1~ee $10.00 ( ~-\
U ~rcopy )
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or setllement of an estate.
PLEASE PRINT OR TYPE
Name (Rrst) (Middle) (Last)
of
Groom
Groom's Age
or Date of
Birth \
Residence (County) (State)
~r~DuTC'0t'S~ ChD
Date of Marriage
or Period Covered
b Search a () \ 0
Place Where
~=was l,(:QQ~~\CLLf\ C\~
For what purpose is information required?
C\('S0\\ 1 f(-r' De:LL:> 7::[)( \G.\ seC0\\1\ }-
C1.cA C.s.\Y\ \\E'W \\(Ofl~_
In what capacity are you acting?
Name (Rrst) (Middle)
of
Bride
Bride's Age
or Date of
Birth 3-6-1q 3
Residence (County)
of t\\. .
Bride \AJ\-c'()e"S~
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was S\- to\untc..
Performed .
(Last)
(State)
What is your relationship to person whose record is requested?
If self, state -self. - ~ \' f-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applicant
Address of Applicant
DOH-301 (3/93)
Please print name and address where record is to be sent.
(PLEASE SEE REVERSE SIDE)
-,,~,'.-....--.w.,__._.
ff23
..
rI~'~
:"'::4--~._",,__ _...._,_~......... .....i.. J _ ~;. ~
-
"----...-..- '.----.-----...--..--.------'^..
\.
'.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
W1der the sea/ of the He8IIh DepaJ1ment. includes the names of
the con1racting parties, their r88idence at the lime Ihe license
was issued as well as dale and place of birth of 1he bride and
groom.
A Certification may be used as proof that a rrwriage occurred.
SeIRh am 0 F "1',+ E.
CerIiIied Copy M A J).SU A-(, f []] Fee $10.00
~-rIFA1'c percopy
A Cer1ified TnIllSQ ipt includes aI of the items of information
0CCUTing on Ihe original record of Ihe marriage.
A Cer1ified TnIl1BCript may be needed where proof of
PfHIlIBge and certain oIher debliIed information may be
required such as: pnporls. vetenwl's benefiIs, court
proceedinga, or setIement of an es1BIe.
:~~;:~~?;~~,';~.~:.x..::.., . ,: ' . .'. . ., .~~;~" .~;~L
(Middle)
(Stale)
1l-6L./t-t./D
\
l)
Name (First) (MidcIe) (Last)
:.. (~N tJ.6L.J\ H.~jl. I~D66-1 I O('~a,~.
Bride's Age
:,..DaIe of 61 f(1 ~~
Reeidef k;Er (County) (Slate)
:- ~ U&l.-l ~ lfL6/'-flrIllO
If Bride PnMousIy
Mmied. SIBle Name ___
Uaed III That Tme
Place WhEn
MlmageWas t.fOL'I CROSS
Pertormed . N. \.1
S tSL.-F
If aIIomey: Name and I'8Iationship of your client to persons
whose IUS" idy., record is required.
~ te 'J.. b to
PIe88e print name and adchss where record is to be sent
r1 V Cr-u ~ -1~ P '1 ~ R..l\1 f
o
E tlCbI G-A (4) c;.", s
(2)t~31J N
u ~N1G~V'M:I
~ -
11.. 3J41f qUlUsII~EVERSE
001 (3193)
(Q]~~~~~aJ~
~L
33416
5~/- ~a5-la 19
Sbl - 'i d-I- 3 00 ~ ( ~)
Tagairti/Observations
o bservaci 0 n es/Pozn a m ky /Be mcerkn i ng er /Verm e rke/
M a rkused/napoTTlP1l0tlC;/Observati 0 ns/ Osservazio n if
Pi ezim es/Pasta bos/M egj egyzese k/ Osservassjo n ij i et/
Qpmer:ki~gen/ Adnotacje UrzlFdowejObservac;:6es/
U radne zazna my /Opombe/Lisamerkin nat/ Anmarkningar
,.~;~X\~~!t~!*:~ Eire II rela nd I i ria noe
SAGHASITYPE ITYPE rIR/COUNTRY /PAYS
PAS UIMHIR/PASSPORT NO/NO. PASSE PORT
P
IRL
PT0165154
1 SlOINNE/SURNAME/NOM
O'SULLIVAN
DATE OF BIRTH/DATE DE NAISSANCE
/JUL 1935
TE OF EXPIRYfOATE D'EXPIRATlON
L/DEC 2016
<) (JOARAs I AUTHORITY IAUTORITE 10 SINIU !SIGNATURE /SIGNATU RE
L
Oifig na bPasanna,
Baile Acha Cliath
Passport Office, Dublin
P<IRLOSULLIVAN<<JOHN<<<<<<<<<<<<<<<<<<<<<<<<
PT01651548IRL3507131M1612181<<<<<<<<<<<<<<<4
~ oC;, ~~ \1.') ro P1 Df'l
PuJ'M &t)J- 4 Jvt~
.--
1-1- ~>i.iJ~
IDI6/~OiO
. s 8 J--- () \ j~ ctw\ Q~~A1l,^~ 109ft C( g.oc1<~ OM.(
CJ2jLt~J c0h~ i '^"'j W'\().(LRla<p auJ.~ca&
""'P.~ltt',,,
-,~J-"'1:,~< DONNA MCCABE
~i "*~ M COMMISSION # DD 695616
~*"..../ XPIRES: August 4 2011
',,9(.1 ... Bo d Thru Notary Public UnderNriters
#~
1981-
905 augll8ta pt drive
palm beach gardens
florida 33418
phone 5616251219
fax 5616256708
e-mail jrosullivan@comcast.net
C ~VII".sJt~
wJJ J4k ~
..
C2.v:>
~
Awf.
Je.-J~ (J ~
'1 IWtGVL~ ~
~r~~
Q./tJU.Vl(. .
~~.
f
o iJ(. CJ-
'I
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Col!)' of Marria~e Record
Se~chand D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Se~ch and
Certified Copy
H Fee $10.00
I2SJ.. per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a m~riage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
..--."".--.-......-.,-.. -......,
Name (First) (Middle) (Last) Name (First)
~ cl
Groom L v eX..... Bride
Groom's Age Bride's Age
or Date of <t'1. or Date of. .s t
Birth _h~.__~d,=L... '1.1 q.~~L. -_..--._--~~_._.._._-A.\.I~~_L_
~esidence ~(..*;:;J;,S:a;e) I ~fesldfmr.:e V(CounfY)
Groom II .___~~ .! Bride " <J r c...~_
Date of Marriagn i 'f 5-ide PrevloL~Ji' U
or Period Covered -c:.sl. : Farried, Stale I'~ame
b Search ~ ,) \1 ~~ L1$-L ~$ed at That Time
Place l,Nhere T Place Where
Ucense Was Marriage Was
Issued .. .. ......... .~~~!!~f~..:..~~\~~:+{i"1. ;~..-- '. ~i~:~~T.~;..::....:f.,.'~..:.::~:::~::.~.::.,:..~ :':":':'.;:'.:.:.:.:.;.~':......~:..'.'..'::.":'W:i:'""};::::::::r.~;:~:M'"
~~)&~I?:i:li;j::i~{,;i::;:~1~ir::~;:~i#.it.::4i:f:t~~~:$~lj~ii:;i(:~~::;~:; ''''P.c........... . . . :.:<,.:. ,,;.;
For what purpose is information required? i What is your relationship to person whose record is requested?
Lo,*,- at c(i' "J i~\' ~~ i" "ell, stale "s"" S e \.G-
In what capacity ~e you acting? rtt' al!on;ey; Name and relationship of your client to persons
"ti~"" marriage record is required.
(Middle)
(Last)
be)
(State)
N
----. ~,-->-~-_... --_..~._---_...._-.~~--.~.__.~-
'~~1Ii~~j;;ii:.1~11~:;~~~~'_:li~~i~ii::1li1i~:Itiil~l~:*t\f~::
:;>:1te
~~(C~OW~[Q)
(pLEASE SEE HE:VERSE SIDE)
_.~,_..... ---f}ff-j'-Z--70
TOWN OF WAPPINGER
TOWN CLERK
DOH-:3Cl (2S,':.
,
.,.'"
..
.
-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
SeMchand D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle)
of- ~ \
Groom l_~U1 L\ C
Groom's Age
~~ate of ~ !;)~ /0(
Residence (County)
~room I~LI/ R~ ~/U w
Date of Marriage !
or Period Covered 4"': K"_ C. / .
b Search "") / III IJ {P
P.lace Where 1.,01P r-l' s
Ucense Was \j\J l pe...t, 1
Issued
(Last)
Name (First)
of ;-.....". ._
Bride 1..)C).A).J ~
Bride's Age
or Date of
Birth
Residence (~n}Y>1
:ride 10 I ~& {v{ ,. II
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle)
m,
<:(-1 r&/ ~ (j
(Last)
IJ.J--e ~
r<d~
l5
R~~
For what purposl:nformatiOn required?
iliAJ. Q;n~
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date 10 t( //0
Please print name and address where record is to be sent
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
-
...:
.
TRIBUNALE 01 RAGUSA
PERillA EXTRAGIUDlllALE - TRADUllONE GIURATA
10 sottoscritta Dott.ssa Petrolo Maria nata a Ragusa data 11/01/1971 e residente a Ragusa, in Via
Parigi, N. 7 laureata in Iingue e letterature straniere, su richiesta del Sig. GIOVANNI FIRRITO,
residente a Ragusa, in Via F./Ii Belleo n. 89, ho proceduto alia traduzione del documento redatto e
rilasciato in lingua ITAL/ANA e che nel testo in lingua INGLESE risulta essere del seguente tenore:
Via Fratelli Belleo n. 89
97100 Ragusa, Italia
Town Hall
20 Middlebush, Rd.
Wappengers Falls New York 12590
lit
~ .,
Attention: Town Clerk 0 1 09 146127 ii,-, ,~~::~'"
'. ""'"'' 111""1/1""""" '~~~ ;)p:i-/
I, undersigned Giovanni Firrito, born in Ragusa, Italia, on March 23;'~~ at the
address noted above, submit to your office to obtain a copy of my marriage license. I
require a copy of the license as proof of marriage to Antonietta Alfonso for the purpose of
obtanining her death certificate which is needed for my re-marriage under religious
ceremony.
Sincerely,
~n~~bYfirrito ~iovanni .
/ / K?- /~ Dj r),;<.-r"--
The above signature is true and authentic and was placed on the document in my
presence by Giovanni Firrito, born in Ragusa, Italia, on March 23rd, 1935, living at Via
Fratelli Belleo, 89 Ragusa (Italy). I, the Notary, confirm his identity.
Ragusa, 11th October 2010
Official Seal of the Notary: Falco Giovanna di Vittorio, Notaio in Ragusa
Stamp duties: €14,62
5 - I f- f1.,
-1t 59
r1<.o~W' . '\./0' 'RI(" ..5 "r""j -.~. :--w,-~~>.~
l:~r .............. ...L ................ . ...... ll\.1tt.1
cor"m~.io"Gfol:i~DRI\lERLIC;ENSE I
10;757 258 032 "". '>C,' i
. > .... (~ i\ . i
r ..~~~.....; :
'. ..... ; .,WN,U
1347' AT .\" . "
-'WAP,PI '. . .fI..S.NY12590 . q
". S~..:.. 'F EY. :.." .i'.'Nt~.s.07..ClA$..S:IDi'" '/
. IE;, '. '.;' \""... . . ..-. 'J'
I$SUEO; ~2lRI)';'EXPIRES; Q8..13-12" I
..... '. '-, .;, -- " '--"-1
~,. , 6091~J
."."""~ ~.....-.~....::,:,:>l,";
~
...
o jo- J..,/O 4-'
__1,~ ~~~
-~-~&-fJ =~
-~~~.
~:~. -----~. - ---------------
-.------
.----
~,------,--
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
Search and
Certification
D Fee$10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health [)epar1ment. includes the names of
the contracting parties, 1heir residence at the time the license
was issued as well as date and place of birIh of the bride Md
groom.
A Certification may be used as proof that a marri8ye occurred.
SefRh IW1d
Certified Copy
fV'I Fee $10.00
L..CY per copy
A Certified Transcript includes aU d the items of information
occt.ITing on the original record of the nwriage.
A Cer1ified Transcript may be needed where proof of
parer~ and certain other detailed infonnaIion may be
required such as: passports, """'8 benefiIs, court
proceedings, or setIemeIll of an estate.
~~:"~f;;i;:;;a;::~\'~::;..,,{', ":' ". ,." ":"'<;" .'~' ." :::#,:~'<_:)
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
:;~ate of J/r;;). 5- 6 I
Residence (County)
:oom 'J) /L-~h~
Date of Marriage
or Period Covered
Search
Place Where
License Was - f'> I \
Issued low n c) T IIV
(Middle)
(1..as1)
rs
(State)
/- 9-~3
For what purpose is information required?
-l.-:ilarrh:f ~'c Cl+\h~
In what capacity are you acting?
Sr-;~ ~ ~ ~ r"Y)
Name (First) (Middle)
d
Bride Jo RN
Bride's Age
:..u,DaIe of 9 ~;)..,9 - "6
ResidelIC& (County)
:,.. i)ui-~5
If Bride Previously
Married, Stale Name
Uaed at That Tune
PIBce Where
Marriage Was C'l m
Performed QT. , , I cu-
(last)
(State)
1''''
If aIIomey: Na.ne and relationship of your client to persons
whose rnaniage record is required.
-
. ., , , ;': ;:, ", . " '., : . ,::f'f
~>-: '^ . ~ . ~. '. .' I. ::::I.~
-". ." ,
S'
Dele
rr -"60- j'b
P-.e '.
~...l-L...
_....: _L..
-ent
Mrs. Joan Mwrs
Unit C .
23265 Castillia Way
California. MD 20619
(PLEASE SEE REVERSE SIDE)
TOWN OF l^!f\ PPTNGSR
. . ............. ............_....01._.......1... ......._................._...................................
'OFFICE OF TOWN CLERK
CERTIFICATE OF MARRIAGE REGISTRATION
Record No.............~........of y ear.......J~L9)
I THIS IS TO CERTIFY
that... .~~.~~. ~.l;1. ..~~.~~~................ ................ .residing at. .!J:~:P.P.~.~g.~~.~(. ~~~ ~~,... ~!...~!.........
City &I State)
who was born....Ap.~~.~...?.?.~.. .~.9 ?~..... ...... .... ':1at. ..... ..~~~<?~~L .~!.. K......-! .... ... .... .................i.....
~Ol;\te) .' I (City &I State) ,
and...... .c!.<?~~.. ~~~~~~~.~................ ....... "'" ing at.... ~ ~p.p.~~~r.~~.. .~.~.~.~.~l...~~...~~.......
'[ ~~ (City &I State)
who was born.. ....... ~~~l?~I.. .....L ~....~.........at... ~~~..~?~~..~.~.~..:~...~.~..~~.........................
( tel . i (City &I State)
were married 0 ......~ ~~~~.~. . ~.9.~... ~~~ ~...... ..at. .~~p. ..~e;~.~~.. .~.~.~~.~.~.. ~~...~!t.....................
(rjet , I
certificate of marriage of said persons filed in this office.
Dated at.~~p.p.~.~~.~.~.~..!.'~~~~ !'...,N. Y.
.. ..~~~~~~~'1...~....J9.~~... ...... ...........
, ,
[SEAL]
....~;t...7~~........
I TOWN CLERK
I
I
I
i
'-
VS.12 T (7/62)
Any Alteratlan Invalidates This Certificate
Issued Pursuant to Section 14'0, Domestic Relations Low
~....~.II' "..,.. J>.....;..I..'
- _._--_.-..~...'."":"".
DM,.
ltlOlDr Vahle.. AdIIIInlalr8llDn
6601 Ritchie Highway, N.E.
Glen Sumle, MD 21062
14620421014751
DFl'\I~ ~ICENSE / 50UNOEX NO.
07/20/0'1
DATE
JOA.'lI MYERS
23265 CASTILLIA ~AV APT C
CALIfORNIA MO 20619
'.~~~~~-.7'T~~~,~-~~~~~~-~~-~~~~,-~~~:~~~~-~~~---~-~~_.~,
(:13/(:13 3Si\;;,d
3~OlS SiNlddIHS 3Hl
v11S-E98-113E
131:91 13113(:/v13/131
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
tor Coey of Marriage Record
SeMchand D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
~ Fee $10.00
W per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports. veteran's benefits, court
proceedings, or settlement of an estate.
m_f!%ffif:::tt:Y(<'"';i:ik(.1;:-'Y"""'~"'W ".",.w", ,,~:-.<;.:.<+= .'. d :.".,. y..^, ,'" . ,. "<>>"'8y"""W">'~'""''''",...w''';'Wffi,'"(,, "_w"'<<q-;<<_::ii
l% ~fu&i1a;f%4Mi1i.LI&;;:3<;t~LS<i;;~ . ,.:,{.. .~:.. ' :., -;-';..' .... .... :. ',.>..,:~,;.: ~.:,~;J.,~;. '.;w, ,:':;''::;;;i,;;,:;ti~XI &illHiW0h ~
PLEASE PRINT OR TYPE
Name (Rrst) (Middle)
~room If,
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered i...J.
b Search f'
Place Where
Ucense Was
Issued
(Last)
(Slate)
For what purpose is information required?
LIJ }" '(
In what capacity Me you acting?
Name (Rrst) (Middle)
of
Bride
Bride's Age
or Date of
Birth
Residence (County)
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
(State)
/VL
What is your relationship to person whose record is requested?
If self, state -self.- J'P. (F
If attorney: Name and relationship of your client to persons
whose marriage record is required.
y~
Addr 0 Applicant /) I
SLy 11 !l/lO() It /~ C1
foCtr41r-ee/5(C vy I ~60 J
DOH-301 (3/93)
(f) I~ 10
PiW'~ nC~l(a(i~ where record is to be sent
SLy /, !l/'c~ Ir /( cI ~tI ?/-( lr't?e'/5'r 'C
/7 b (J
(PLEASE SEE REVERSE SIDE)
"
.
(\ . ~
y
Where to Apply for Record of Marriage
1. License Issued in New York State (Outside of New York City)
Year of Marriage
Apply to:
* 1880 to present
Certification Unit
Vital Records Section
P.O. Box 2602
Albany, NY 12220-2602
* 1880 - 1907 and license issued
in the cities of Albany, Buffalo
or Yonkers
Albany: City Clerk, City Hall,
Albany, NY 12207
Buffalo: City Clerk, City Hall,
Buffalo, NY 14202
Yonkers: City Clerk
City Hall
Yonkers, NY 10701
2. License Issued in New York City
Apply to the Borough office of the New York City Clerk that issued the marriage license.
The location of these offices follows:
Manhattan - Municipal Building, New York, NY 10007
Brooklyn - Municipal Building, Brooklyn, NY 11202
Bronx - (Records for 1908-1913 are on file with the Manhattan office)
1780 Grand Concourse, New York, NY 10457
Queens - (Records prior to 1898 are on file with the New York State Department of
Health) 120-55 Queens Boulevard, Kew Gardens, Jamaica, NY 11424
Richmond - (Records prior to 1898 are on file with the New York State Department of
Health) Borough Hall, St. George, Staten Island, NY 10301.
PLEASE NOTE: Records of marriages in areas of the present City of New York, which
were not part of the city at the time of marriage, are on file with the
State Department of Health.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' of Marriage Record
Search and ~
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee$10.OO
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports. veteran's benefits, court
proceedings, or settlement of an estate.
<_~.w:::"~.;:;:?-:">>~%"'*:-XW;':-'";'-~<S<<""'':;'-:'~~''~'-X-:''''':::'''''-:"?='''X':;:.~~........-; :.....^~ 'K'" ~ .. ;,...... .....;....,,{"'''%/...~:-<<:x>>--:...:::.:;..'''....%......(....... <<::-:x~i'""'''',('''=::''''%';'''.:?S:Y.:>:::w:<<'''-:~m_
t ,:J~~:'{1.4n//"i::~/i ;;: ,.;u:,) j <:~;< : :,,1 ;: . , .:; ,. .;) u ::: >:; ':X .... ;'. ~;f A.:J ..41<''''[1 ~qp<t-.'":41f ?:>
... .......~&"V7N"=.~::<x~>X.m..&;:.......:../..:.:-:.%:. :.y..,........-:~..:(.:v.. . ';":.,...<-. ..... .....~. . "," x'j......"":v~. ......:-.........//. ...... .:--......"'. .............>>.... :--..>>*....>>:.............00... :::;:..:-..>>.:.<<......:-..#.<<:m......~
PLEASE PRINT OR TYPE
Name (First)
of '"\')'
Groom ~\~\
Groom's Age 5 8'
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Middle)
~
(Last)
~~ '(JJ ~~~I
\;
Name (First)
~~ L-\ I\,~
Bride's Age S-3
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where ~'<-f ~ I I). d
Marriage Was
Performed
(Middle)
Lo~\ k-
(Last)
:...5
(Sta}tl i
(State)
"'y
SoL-, ~
~
VVhat is your relationship to person whose record is requested?
Ifself.S~~~.~~. s:.J~
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
(PLEASE
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
n Fee $10.00
W per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
~~~ate of ~?-b C(\
Residence (County)
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was I \
Issued \I\J
In what capacity are you acting?
-\,1 \j~).~ .
'"' \
(.
Address of A lieant .
\\ EW'v\l~ ~~
~\ falij I ~. (J~1c).
DOH-301 (3/93)
Name (First) (Middle)
~~e8,
Bride's Age
~~ate ofq ~G{
Residence (County)
:ride ~S'
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
.,
(State)
Y
Daq\Q-A\\O
Please print name and address where record is to be senL
(PLEASE SEE REVERSE SIDE)
. NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coe.v of Marriage Record
Se~chand D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
_~"?t:~:X=%-:{-~";'B:?/'<;'-:''''''''':'-i''m,,,,,;-v,'~:x::::'~-:</'>:''''':-r'''~~'.;x;:.<:.....:;O:~v.<.o)~~.Y.:.....$>>..........<'Y'0..;..:-<:.(.>>.I'.".~;;:t.:.....;.::-::~v.:<<>>.'"-:.::.;..~~....<<~X0::'''<<:''-=-=<~~.~;'~;':~''''''~~~
/::..:=:~ 0::t:;;'~:::~~:::: ..:;~; .j....~ < :~~ <<... ~~.: .:;: ~~.. \ ;:" . ~~ ~ ~ ..::... ..~ ~ . (... ~~:. ~ ; ; :~ <:;:: ; i ~.: :.~ :.~.. . ; ;J . <;::..A:~~ -:}~t{'"& S*::!:~<~.}\ ~
%%,=llWLdAdi0"='J;:"":<<~"::::""""'''~:'<-'NY '" ." . ;O~ , ,:.:. .,~:~, ,." '.""m >>:>.m..,<;i::...;y ..,;t:&:.,.;',:",,* ..".".'.."h~A,,,,d(:;U::1{o>>.:,, ffi;t,,,,.*-M%
PLEASE PRINT OR TYPE
Name Jrirst) (Middle)
~room Kok-f
Groom's Age
~~~ateof 1 / ~J /7/7
Residence (County) (State)
of L L
Groom tl TCJ'-l.S S N
Date of Marriage
or Period Covered L .., /4 , ..(,
b Search <X / TI
Place Where II I tr: ,/ /
UcenseWas WOfJIJ/~ ~d.s
Issued .
Name (First) (Middle)
~~ 2t ~ f2 ~
Bride's Age
:~ate of /1 / Go /.;1 ,J-
Residence (County)
:ride J),,~ss
If Bride Previously
Married, State Name ~
Used at That Time
Place Where 2.. .,
Marriage Was ~
Performed
(Last)
(State)
IlJY
~-p/.sCcJP/J-t... cJ, '-{
eA' ~11..r NfL
For what purpose is information required?
IIdem/1-s kaelih IJ... $ttIVIV/I1e?
I ......,
"
reCIV re-
Signature of Applicant
~ ~ /'tfl}
Addr Applicant 6
K'5 ~ 131 - c:2 I
Po ~ e; lL a.-3 pJ r lolf/tJ
DOH-301 (3/93)
~~~~~~mSE
SEP 110 2010
TOWN OF WAPPINGER
TOWN CLERK
VVhat is your relationship to person whose record is requested?
If self, state -self.-
If aUomey: Name and relationship of your client to persons
whose marriage record is required.
Date
? --10' - /(J
Please print name and address where record is to be sent
})u7CHc'5~ <!.Qu,vT'1V4;I2:"""KA~ SaA/ICc,t}(;6
d42 rn ar~(- S7. r "t:f f/(Jd'-
~Uq)zt..ups/~,/ /c1 "y'. /02.6"/
i:./ ... ...::Tt3S Ie/!
REVERSE SIDE)
1 ..
IN.P.' ~..YORK ....SI~!".k.ifil
~~ ........1
Comm$~prrerofMolorVehldes DRNER LICENSE I
ID:910 391628 .'. I
..... ,. !'. I
Doa: 12-21.-54 - ~ . /
KOBOS,ZITAE .
t56 ROUTt; 21' .
POUGHQUAG'i " NY 12570
,~~X:F EYE'; sa.:\,:HT: ~ CLASS'D '
l~lJ~Q: 11~~. }EXPtRES: 12-27-11 1
'il4.~ J~ c .'. 5469939() I
..,....=".;:c"... ,~:c ~=~...,.._~.'~" .:cd
,"4,,,,L.,""""'_...',_,_d:;"'.._..~,,_.'.~,_
"
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
Search and 0
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of !he bride and
groom. '
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain o!her detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or setllement of an estate.
'_@:r:;;..::::?.;..:....m......;.M:.:f,<;.."-:y.~.,-.:::........"~:::...>>.o/-.:...".......->>......z....:::.~~...::%:? ..-=:...t.;'::-:f'.~" .::;... ....... ;.:..>>>/'.......-.;::;.......:-x~..<.y>>..<.....::......<;.:->>'..:.%:'..~;y.....<<.":...;:<<_~::-:r<-:.::;'@=-=:,:w_
~ ~4{&j;@ii;:~k%f;}t.L;L};~,4.1\,;2'~: . ,,' :'~:,~ t u,':,;,};.,; "< j,:'):;,;;,.\L~:;:L!oL i::2;, ~;,j;dfL:<M ~*=%K\W$iRr ~
(Middle)
For what purpose is information required?
In what capacity are you acting?
Name
of
Bride ;\
Bride's Age
or Date of
Birth
Residence
of
Bride I ~
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was ~
Performed I av; rL
(First)
(Middle)
V.
(Last)
VI -- J.StJ H
03
1 /0, . (96 ()
(County) I ( C /t "'S's
S 7 1/ tlA) if a:fI:
(State)
V\lhat is your relationship to person whose record is requested?
If self, state -self.- 5e ! 6
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
q'!O'IO
Please print name and address where record is to be senL
(PLEASE SEE REVERSE SIDE)
..
,
--l
CJ"
\
.....0
-c
~
'::4-
"0
ex:
--------
.~
.'?
.
/"
<Ew YORK STATE DEPARTMENT OF HEALTH
Vital Records section
O Fee$10.00
per copy
A Certification, an abStract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certmcation
A Certification may be used as proof that a marriage occurred.
PLEASE PRINT OR TYPE
Name RFirst) (Middle)
of J _ J
Gr O~
Groom's Age
or .Date of tl /
Birth I d-J /7/7
Residence (County) (State)
of
Groom u~s~ N
Date of Marriage
or Period Covered " J /. .
b Search l"'lCl IJ. 9 'I'
Place Where
UcenseWas tucy.;fJttlerelS hils
Issued (/
APplication to Town/City Clerk
tor Co ot Marria e Record
O Fee $10.00
per copy
A Certified Transcript includeS all of the items of information
occurring on the original record of the marriage.
Search and
eertifiedCoPY
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefi1s, court
proceedings, or settlement of an estate.
Name (First) (Middle)
of 2 ~ IJ
Bride t ~~
Bride's Age
or Date of / /
Birth II" / ;l.r-
Residence (County)
~ride '])/L /-cJu Ss
If Bride Previously
Married, State Name ---
Used at That Time
Place Where -'7 '...JJ
Marriage Was ~I MrV ePI S C-dPIlt.- ch (.{
Performed tv '/j e~ ~'b- /II~
(State)
IUY
For what purpose is information required?
J/eJ-el?:t/7-S k;ufiis ,& ..5C.frv/lIlat:?
--
"
rece; re-
Signature of Applicant
. ~~
o Applicant
K370 ;0I.cJ-1b
ht~~7t(tl-3 fJ Y I~n
DOH-301 (3/93)
~~(C~~~mSE
SEP 1,0 2010
TOWN OF WAPPINGER
TOWN CLERK
What is your relationsh" to
If self, state -self,- Ip person whose record is requested?
r 'tJ11 (/.-r
If attorney' Name d Is" .
whose '. an r~ tiOnshlp of your client to persons
rnamage record IS required.
Date
f --/0' -/(J
Please print name and address where record is to be senl
7)u TC-HE-S~ (!JJlltJJ11 Vt.:-n:r:1111J,4 5CX1/lc'C 1}~6
cfl.:1.. rn ar,t...e r 57.. f t::i 11 d d r""
f/ouJALups, c.I /If l-Y /026 II /
177//: Ji?5S Ie/(
REVERSE SIDE)
Sep 13 2010 8:14AM
HP LASERJET FAX
p. 1
~
.~
.
ETTINGER LAW FIRM
ESTA TE PlANNING & ELDER LA W
Head Office and ~a1llng Address:
12.5 Wolf Road, Albany, New York 12205
(800) 500-2525 · FAX: (800) 500-5445
trustlaw.com
FAX COVER PAGE
NonCE: The infonnalion included In this Flit Cover Pale and any aocomplll'lytnll documents is intended soleI)' for the m:iplent
named belClw. The mfOnJIltlOll may conlllin confidential IlId lelllly privileged communlcatiorlll between attomey and e11elll. lithe: rclder oelhis
~B5l1le is not the rvcipient named below, Illy readiRl. dissemination, disll'ibutlon, c:oPyinl or disclosure of the conlents of this lIansmission is
prohibitecl. If you have received this Iran,mi'lion in error, please not1~ us ImmecS'etely by telephone at 800.500.2~2S and return the conte nil to
us Ily mail. We wiD reimburse you i'a'the poslalle, Thank YOII forycur CClDperatlon.
DATE: September 13, 2010
NUMBER OF PAGES (INCLUDING THIS PAGE)~ 1
TO: Town Clerk Wappingers Falls
FROM: Elizabeth L. SchaJk, Medicaid Supervisor
RE: Zita R. MacDowell and Robert W. MacDowell
COMMENTS:
Our firm has appll~d for Medic;aid on bebalf of Zita R. MacDowell through Dutchess County Department of Social Services.
Dutchess County DSS has req\leste~ that a Veterans application tor aide and attendance be filed and wrlnen vel'tl1eation of the
filing must be 10 them by 9/22/10. [n order to c:omple1e this task the daughter Zlta Kobos must have a copy of her parents
Mmiage Llcens~ for the VA to show that the veteran was truly married to the applicant. Mrs, Kobos has informed our office
thai you could not release this to ber, although she holds her mother's POWII' of Attorney, unless)'Ou received noti~ from us
that it was required. Please let th[s serve lIS notice that this cenlfictlte Is required and must be presented to the VA representative
1omorrow morning. MllTiage was pcrfonned on 05/12/46 at Zion Episcopal Church in the Village ofWappenSllrs. Mrs Kobos
will be in to ))ick this docwncnt up this afternoon, if you need to contact her please call her at 84'-227.36S7.
SBNDING TO FACSIMILE NUMBER: 845-298-1478
RECrPIENT'S CONFIRMING TELEPHONE NUMBER: ·
Ettinger Law Finn - Albll/lY . FlShkill 'M:.ddlelown" NYlICk ' lUlinebeck . Saratoga' Staten I.land ,White Plains _ 100-500-2525
,/
(/1~- ---",W--~ ,/O;~-- r)~jf' ..- 'r 1'/::1, '-I,fE7:21
~. ..... ". I .1'\.r'-..... .3.,a,l":..c.lf,,,..;i_..~'~.i
.~~ . .' .,;
Commi'&On.:fMo'orVehi~eS DRNERLICENSE I
ID:910 391 628 ". .... ....>. f
o . ";22 I
I
!
t
1
r
!
D08:12-27-54 '--_00. J
i~!~~~1 c NY ;l,stoJ
SEX:F EYES: BL. HT; ~2 CLASS: 0 "'f
'~6Eq: 11~~3~;;:kxPIRES:12-;'-11 f
.'Iit.;, '0,' . Ii,: '. 1
. ,~;i',~ 54699390.'
~-,~.~ ,~,'~'___'';o-",,_.__''- J
\........_.,...""..-~,~"J:;,._".:_-=.c,.__
--. ~........ --'- -v.~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Depar1ment, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
~'u!tktSlt:'ajt;L;~~:~:.::.:r::,:j,:::1;:':~":::~:;' ..^':.':~~" ~~.'~':'.":~':~,.:::>::.'~::.Sif;,::"L:':~<':~;'.::::;rJD~:r;~_rr.~}fl)&J_..
PLEASE PRINT OR TYPE
Name (First) (Middle)
~room lHod)~ ..J
Groom's Age f
or Date of q n /4-$'
Birth
Residence (County)
~room \) liTe Hess
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Last)
D~
I~O
(State)
~.
In what capacity are you acting?
Name
of
Bride
Bride's Age
or Date of
Birth
:esidence {Ju. ~~~S
Bride -lJ t s W
If Bride Previously
Married, State Name I' \ I 'llo. l'" n :P ex:.. lJ II~O
Used at That Time rt JA.-U N L'Y pc IT
Place Where
Marriage Was S~ b G~ (' N-Il S E - Wt9- ff> . If h-Ils
Performed
(First)
(Middle)
(Last)
(State)
What is your relationship to person whose record is requested?
If self, state "8eIf.- tP I ~ t:. .
If attorney: Name and relationship of your client to persons
whose marriage record is required.
"dl%lf&.lr~8rgktm::E~]:S~f;:;:':;~~~':(,.:~i:~:.:E.:.\~>":: ..; ~ .::~. ::.'~' '. .':~' ::.:':~.: .:;.<.,~:./:. :;:::::~.':: .:';:"::;.:~::..::~;::i:2L~;L}i.2fi~~lir;l;jtl;tWtjll
Sinnatu~ 1~pp1pp1icanicantt D
.~ T~ d~
Address of Applicant
~! W~ xU-.
WMJPI NG E (L<; F'1l- Its I
( '2&Cf{)
DOH-301 (3/93)
Date QI'1I'D'
Please print name and address where record is to be senl
R t(. tJ ,..:) G J5t:C.C f-( I ~O
3b lA'~ sT ~.
/).!>APPftJGZ.~s. ~ ll~ I (~~C)D
(PLEASE SEE REVERSE SIDE)
;-
..
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriage Record
Search and
Certification
Search and
Certified Copy
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
o
. (
For what purpose is information required?
\lVhat is your relationsh~.~ose record is requested?
If self, state .self:
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
y]OfA~(eSQ BI<)l
(JQPP ,'rset5 ra(J~ NJ
Please print name and address where record is to be sent.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
11 /3j)'
~a~
KEIL ,
'P'AMELA,ANtf i', "J
,sa.OSBORN'~ Rq LT33
"'~NGERSF:~ 1.
~: 09-1a..1O,':'1::1"
Sf)(; F EYES: 'IlL: Hi: , s.G3
E: NONE lit!,:....).. ,,'
1\: B <Ii,
ISSUED: 12-29-09 EXPIRES: 09-18-11
S2GAWWN05
I'
'.
,
i
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CoeY of Marriage Record
_'I1j(fr!J;jJ}f~'jtf~~::1~~~~:tt~~~~;~::.:'~? ^~}y .:~~ :"~. ~ .:~ ~ .::.;~:; ?~~~~t .:;:~ ~':~{;~;'~~~~~:\~;~:~~1;~/~Z~~~:~~i~C-f-t~fu~*.J_
xw.,....:r@M~:@.m~..~..>>]...{. '-:.' ...-c-?-,.<-<*'=.:,......~>>:;;x~...... .<<....6:../.. >><-.> .. .... .....;.{~... {'A-.V.V' .<<.... .!.:......<.>>.:::&:..w .:::~..;.w~x..:x.:..<.m:.~$~..x::::W.X0*=
Se~chand D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Depar1rnent, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
~entage and certain other detailed information may be
required such as: passports, veteran's benefils, court
proceedings, or settlement of an estate.
lW_*$@$<<m;.:?"~:-"'v~ ::;:;-E~^:-"/~v",': .......v x~..~:: ":-",,~'..<.m-~~""-:"'Y""""7~..~~""'-' ,x.." ....;- ..:-."'';:;.......v;:.:..t:>x.%':.....:::::>>:-:.. <. .z-::... ;<;';.:.,.)':~....v/...:~.~(. ~>:: ~s~~'<<~&:;:;.~>>:~Wxill_
I :~ig#ri~?8~;r;J.1k1tt:t;.:<<<~;~:f0;~1~;~~~:.:~~~:~ ~ ::4~ ~<~\t.~5~~~ =: ~. :~~~ ~~ ~.~~~.;~. ~~:~:~;&..~}.:..~.;. .:~~:..;L.;:::;;3~1~~i}.iWJfl~*fi}ff1Mr
(Middle)
(Last)
36
(County)
hJ1JSS
1[' 0
NL
For what purpose is information required?
&J dl + tV) a / rCJP'-R.S
In what capacity are you acting?
l Z )1()
DOH-301 (3/93)
Name
of
Bride
Bride's Age
or Date of L ')
Birth -:J 0-...
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was Q', M
Performed ...,j.T.
(Middle)
(First)
V\S-hV16
\/\/hat is your relationship to person whose record is requested?
If self, state -self.- .
S-Q)+
If attomey: Name and relationship of your client to persons
whose ~age record is required.
Please print name and address where record is to be sent
sa~
+-
(PLEASE SEE REVERSE SIDE)
~[~JC~
AUG 2 S 2010
TOWN OF WAPPINGER
TOWN CLERK
..
;.
/
~
~
\)
'<J ~
U
"'-
~
~
''t
.-\
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CollY of Marria~e Record
SeMchand D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the lime the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
~ Fee $10.00
LCJ ~r copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
PMentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Middle)
(last)
3D
(County)
(State)
D
For what purpose is information required?
TO Y~H-- ~){!r (1\(Af~ '( e~rc
In what capacity Me you acting?
>,Q \~.
Name (First)
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle)
(Last)
(State)
o
What is your relationship to person whose record is requested?
"oelf.___." SRI t
If attorney: Name and relationship of your client to persons
whose marriage record is required.
\ J5q ()
DOH-301 (3/93)
g!1 (1)
Please pri t name and address where record is to be sent
(Y1icVtt.\li f€fttgftw
11 \
a
AUG' 2 S 2010
TOWN OF WAPPINGER
TOWN CLERK
NYS Department of Motor Vehicles
INTERIM LICENSE
721541866
****DRIVER LICENSE*****
MP329203 AUG 19 2010
REB F.. 13.50 PGK535
Visit us at www.nvsdmv.com
MP 329203
r...
I ,-
, "
NYS Department of Motor Vehicles
J"-7.(()
=tt f f'
INTERIM LICENSE
721541866
cra.. D
Restrictions B
.
,
.
,
.
,
.
LU':
3$
....
~
i!:
~
o
~
Cl
....
~i
Endonements NONE
Slalus lerminales on 0 2 / 0 7 / 1 7
Probalion Dale NONE
This do<umtnl e.pires on 11 / 1 7 / 1 0
PETTIGREW
MICHELLE, A
1 7 TWIN RD
WAPPINGERS FLS NY 12590
St. F Eyes BL HI. 5 6
Birlhdalt 02/07/80
Addil;' "'I~eslriclions N 9
\ i'f f\ .
Sign X 1 V' " ' I
Here
K&ep this document until you receive you
MV-1 (6/08) PART 2
NEWYC.iRK'STA~
:\g ~. 'i
<1;.cq , ..-:
DRIVER. LICENSE
10: 721~ 1. 866 CLASS 0
, ,OI,.DENBORG. .." ,
, MlCt:l~,.
',.'.,JACKMAN_IYE.
~HKE~NP.:\~
'., DOS: 02-0710
'SEX:" EYEs: 8f..' HT: 5-08
E:NONE ~
R' B
ISsuED: 02-13-09 EXPIRES: 02-07-17 UPE
~atk~
:I'
."
!.
,
.....
IF
1t197f /77
Application to Town/City Clerk
for Co of Marria e Record
""
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Sem'ch and
Certification
'1'7(' Fee $10.00
~ per copy
A Certification, an abslract from the marriage record issued
under the seal of the Health Depar1ment. includes the names of
the contracting parties, their reeic:Ience at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes aU of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other de1aiIed information may be
reqWed such as: passpor1S. veteran's benefi1s, court
proceedings, or setllement of an estate.
~j~~i~r!i~~~:<y;'~:'::':::':~,:'.",","':)',:::':".~ '~'>':. :.....:" .~: ."'. . :'.' '.', .' "':':?:'"..,.;:/':~i~n~\:\'>7~~:;>:J[;:.;:':I]
(Middle)
JlM/e
(S~)/
Dy'
If attorney: e and relationship of your client to persons
whose marriage record is required.
Address of Applicant
/q/Yl7f~~ ~~
tMJff/1f-t/5 ~j fJi /~S90
e;;"Ehn;d Bdd;;r~ is tobesenL
/q /nCt~7:rrfo5L tar>e
j. I b IV Id-SClO
[Rl~~~D\lf~[Q)
AUC; 2 82010
TO~~~WAPPINGER
__~LERK
OOH-301 (SI93)
j!,u!td IJ~
)
~
MEISTER
. CHRISnNE.M
l' MACINTOSH LANE
",~NGERS FUUfY 12590
008: 02-13-71
sex: F EYEs: BR HT: 5-04
E:. NONE
R: B
ISSUED: 10-18-09 EXPIRES: 02-13-10
TZTT~1'
,.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriaqe Record
~~
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee$10.oo
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
_n>>.;...::;W:-:.::::.::::;:?-:-.::....-:x"::::(-..;:~j-.........,..~9'~;y..>~....:X:<<;.;{.. :::,>>:Y:.:-N~'::::-v..%(.>>: .;oN.....;:;;::... :>-v........ ...." i' .:"'........~....,<< .:::%.-:@::;..::........."..~. ..~..~...::.~^.::x:...(..,:>..<:>:x~mMvft':-=::_
~~k41~BI2&1rtlliEilil-:t~S:L;. ~L.~s<<;;x.i. '.~ ;.!. ii"~ <, ~<: .'.. ";.',. '.' .:~..x{ ..~.'.:~:1 ,~j:. ;<<....:.:;..~Ld..;:L;;;12J&$mI:A}jfeh,
PLEASE PRINT OR TYPE
Name (First) (Middle)
~room ::To f/ tV -:P
Groom's Age I /. I
~~ate of Z I ',26 ~b
Residence (County)
~roorn P~IIes5
Date of Marriage 0
or Period Covered ~ ~. /0
b Search
Place Where
UcenseWas VJIlPF/I,Jrq;f5 I
Issued '1'
(Last)
(State)
AtV.
Name (First) (Middle)
of
Bride
Bride's Age
or Date of
Birth
Residence (County)
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
(State)
For what purpose is information required?
?I? 6..f5- c6 /'?/l R P/;l ~E
In what capacity are you acting?
SeLS-
'Mlat is your relationship to person whose record is requested?
If salt, state -salt.-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Address of Appli
/f? 8 :5~ A, R-.f3e>RoUjIv J'A Nf.-
("u,Irpp I ;V4&1:5 f/ltu-
DOH-301 (3/93)
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
"
qt SS'
7;--7-10
CLASS 0
-,
i
ft
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Cae>' of Marriaqe Record
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (\ ~~rst) (Middle) JL~t)_
~room \.A(\\~\ S(A\ \ \It(1
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
b Search
P.lace Where -t ()--0 V\
Ucense Was \ ' Y
Issued
~l 5 /q q~
(coun~ (State)
--\- S \G\. ~\
'7)
Addr of Ap Icant \ ,
'5 ~ ~lC.t. \ t\-G..\:-~' -
\/0q~~\~C~ ~Ct\~S( ~'i \o51U
D
- ",\\~'~"'"" EMILY MARIE CRESWELL
$'$m~ (J:(,:,~~ Notary PubliC' State ot flO, [I~"l t'
-.. .. - . May 9 20
:, .. ': M Comm Expires .
~ ,,: y ... OD 9811fi~, ,
"':~f r.PO"....: Comn\lSSlon ~ . '
"/~ OF f\.q,..
'1"1111'" .
Name (First) (Middle)
of
Bride
Bride's Age
or Date of t) 3
Birth c;I-
Residence
of l'\
Bride \0"-!
If Bride Previously
Married. State Name
Used at That Time
P~ Where y~. \\ Qa.:<..
Mamage Was \ ~ _J
Performed '-...J'-> a..
(~t)
\\ D \'1\
What is your relationship to .~rson whose record is requested?
If self. state -self.* ~ \ -\'
If attorney: Name and relationship of your client to persons
whose marriage record is required.
(PLEASE SEE REVERSE SIDE)
-.
;-
~ooq
'19,[1
(j if 1t1 c1
f
,.
~
4
"
~---"-ij-~------
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
D Fee$10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
l\71 Fee $10.00
~ percopy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Oroom
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Middle)
"To~('-.
l
(State)
For what purpose is information required?
()\:J~~\';--.,. ~'--o~~ ~\\.'QfS L\ce-~<;JL
In what capaciiy are you acting?
(FlI'8t) (Middle)
:\-"€-f\(\~ ~""
(Last)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
,3
(State)
e~S
What is your relationship to person whose record is requested?
If self, state -self.- Scl ~
. If allomey: Name and relationship of your client to persons
whose marriage record is required.
Address of Applicant
(o 5 ~ G. \.A~QD ~.\\\J'- '\ ,
'~;Q.f\\~ \. \=- L '0 ~ "'8~ l
DOH-301 (3/93)
'l ~qllD
Please print name and address where record is to be sent
lo~ ct ~ ~-eQ'" \=)Q.1 N'- ~ I
~u<<-('\ ~\-\-- \ \=- L ~ ~ ~ ')
(PLEASE SEE REVERSE SIDE)
#/0/
'':,n{~~~ .
1'1<
iY~:O~
DRrvER LICENSE
10: 476 727 889 CLASS 0
DELANEY
CATHERINEIA
3397 ST RTa,;tO .
f'tJt:.TONHAMiNY 121m
OOe: 03-2~3
SEX F EY~'8L HT 5-04
f NONE ".
R NONE
ISSUED' 04-21-09 '.XI'HfS 03-20-14
.
ORO......
DONOR
G8AKYYTP04
r.
1:l: ..i:..r
~^-,_, '. . . ..{::r
J.r..1.-^-' ..... - .. ..... ..JI-"
w-tr~-tr~\
/
.1
.~
7/29110
Chris Masterson, Town Clerk
Town ofWappingers Falls
20 Middlebush Rd
Wappingers Falls, NY 12590
Chris:
I am requesting a copy of my marriage certificate be sent to my home address;
652 Queen Palm Dr
Davenport, Fl 33&9"/
The marriage certificate is required by Florida dept of motor vehicle in order for me to obtain a Florida
drivers license.
Enclosed is a copy of my NY drivers license, application for copy of marriage record and a money order in
the amount of$lO.
Thank you in advance for your assistance.
()i~~
Catherine Delaney d
~ 7;;9/;.
:.=' ~.... .........................
fl'''' QUAL TERS :
: $"'~~"'tl,~ Comm# 000840496 5.
. ::-i'
5 !.;. j Expires 11/23/2012 5
: \-t..fDf: ...~ltj Florid :
: "'''';1111'''' a Notary A88I1., Inc .
,... II II..... II....... ....... ....... .... .....;
enc
~:.-,l-'~-~:4
" lc.~
{'"
",-,:,~".i";"..,,...i
DRIVER LICENSE
;' ~,
-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
D Fee$10.oo
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
~ Fee $10.00
~ ~rcopy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom bu.~~
Date of Marriage
or Period Covered "-
b Search U
Place Where
Ucense Was I \
Issued \)..j
(Middle)
~ q) \q\.Q'J
(Coun )
For what purpose is information required? .
:J() ()h~1( ~) Dr/01a.A:Jrl 'v~If'S L/~~
In what capacity are you acting?
~QA.~
(First)
(Middle)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride G.!
If Bride Previously
Married, State Name
Used at That Time
P~ Where ~* . 'N\.Cl\' ~"'" ~ U-'0dJ,
Marnage Was ' .
Per10rrned W \ \0 ~ \=a1 ~
CX:-* a
(County)
IL.r
L~;C-\
(State)
t=--LD \' \ <i 0-..
/
V\Ihat is your relationship to person whose record is requested?
If self, state "8eIf.- 0QJ ,~
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
~ .1 dDIO
Please print e and address where record is to be sent
Ie> tUn Df LLftfp' ~tjfJ;r
~o lY7 / d.d.J. ebu.sl-] f(CJ. .
u):<.pfl/ it.) .s FaJ I.s./IV Y {d 59 0
. KATIE PALMER
Notary Public, Slate 01 Florid
. . _ Comm. bplr.. AIr 2-7. 201
'C__-. DO,,12
... ... .....
.
.'
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records section
Fee $10.00
per copy
A Certification, an abslract from the marriage record issued
under the seal of the Health Department, includes the names of
the conlracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or setttement of an estate.
;_>>!tW~'ifY%1WJ::.r5S'T'f.:':';)~;:'~f~'1~\~t~:;~':<~'}"~\,' ~F\ :'i'~~r~:~t"': :\r:~:r::7J~~lr\gfw-%''1@'Wlli
i,*Y.w;~m......>>.W..%:>>>>?':-(;'::':<<0:-::<<-::-..: :?~. ..:-"-:.xo:::.:...-:;- ">>~~ ,," ..:v.....-:-......... ':? .N.~;.;..~..-:..<<:...."* ....:... ~....:x:y...... ....w....^'....:<<...:-..:x:-:..:.-:~ ~':-/.:x. .:,';j$&-.zr}l~;t;:;::~m:t;Y.>~~
(Middle)
~MES
~ CADS '"\
(County)
(last)
~E,\\J\\J\
\~I \~8%'
(State)
~
)\.u~oS\ ~q ::lbO,
For what purpose is information required?
C-\-\~E ~~e DN
\)~\.\l ~S L'\ c.e..r"\s.-A-
t O;{\ ~
Address of Ap\>I~cant 0 '
cQl\S- 'i-e... -\e ~ o.~~~'" l-~
W~~\~-S. ~\\sr~'1 \~S90
DOH-301 (3/93)
Name (First) (Middle)
=ride Be-~f\NNE As\-\
Bride's Age
or Date of
Birth
Residence
of
Bride ~~S
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was · . \
Performed \}...J ~ P \. 1""\)
(Last)
\3o,,~
tv\~ \"1
(County)
19&-Y
(State)
~
What is your relationship to person whose record is requested?
If self, state -self.- ~e... \ R-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
to ~D\O
e and address where record is to be sent
(PLEASE SeE REVERSE SIDE)
.
.--
0()
I
~.~
---..0-0
- I
~~
\5
~
--J
.
J.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (Rrst) (Middle)
~roorn GdwCtrd W,
Groom's Age /
~~ate of 5' / '1 L/ ~
Residence (County)
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(lBst)
NtJ/~
(Slate)
For what P\lrpose is information required?
W, " ow'J bene -f,'ts -flu,
S ~.
DOH-301 (3/93)
(Middle)
( Last)
/34/4 sh
Name (Rrst)
:ride 0tA LA.
Bride's Age
~:te of I) Z-~ ~()
Residence
of
Bride
If arid!!! Previouely
Married, State Name
UsecI at That Time
Place Where ..,... JJ
Marriage Was 1'1 t ~ €.. 0 r" /AA
Performed V I { ,
(State)
o
What is your relationship to person whose record is requested?
If self, state .self.- .
If attorney: Name and relationship of your client to persons
whose marriage record is required.
,Please print name and address where record is to be sent.
~
(}3f1#1-e-)
(PLEASE SEE REVERSE SIDE)
~~ht.r~_
{
,}',NOlAN" .c',
hUANNE,Mi, r
:."E.... :::~......~.;.......,I.'NY.... ~'~
ta : 1 ~':e'HT;Ws
E: NONE ~"i
R: B ...
ISSUED: 11-13-09 EXPIRES 11-28-17
77IlCPl771lO
.
~-"
Application to Town/City Clerk
for Co of Marria e Record
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
_~;';."f.~<-""~<';''/'<';''''''''/'{''''''''';'-''':s%'X{~''''' ..y,:,,%(/.....:,.:. .!'x..>>^..~..;o::..... "~V""y':"",,,,,,.,, .... {)to. ~x"</'~::::':X0..... v<..........y-/.N:,.:...::,.............. y.~'W..........;::Y.=:>>.~_
:i;~[;ii:!;2t:L&":;.,;~;;.>:L}~~~;:~,:~:~$5 ;;;:C:i:' .;: ':..; \c~.> ,.;:~:~~J,;i.;1.~.::,;::i;L:\ ~L{~;t;;jt~%f.W€.lir{f&w ~
(Middle)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
:ride ~
If Bride Previously
Married, State Name
Used at That Time
Place Where
~::::as Wo
(First)
(Middle)
(Last)
O~\
<e\ '1
1;-q~ ..
(County) (State)
l\.J
l-::>~ l ~ GCo
(County)
c;:::.
.t.f-dS~ '8;
For what purpose is information required?
~,\rt\ ~CD\CLC::~
V\Ihat is your relationship to person whose record is requested?
If self. state -self.-
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
A ress of Applicant ,
tfq2 t:, tJo-X1J1~ ~d
~Q 0,Q/\ QV ('711- flJ
Please print name and address where record is to be sent
\-;).Sc(O
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
rj-d5- ~7
#3S
,1
~..,~'
,JUCKETT '
,"<' :fiTEPHEN,Ei..
" '\,11,_", "IE NOXQN, ,RD A-2, ..
" '~ANGE"ItUNY 12540
': DOe: ~;:'
SEX: M EYES:,'It,HT",:' 5-10
E: NONE ~"{'"
R: NONE ,""",
ISSUED: 07-1Q..09 EXPIRES: 08-Q9..17
ll2I.ElI734oo ,
../
.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
f';7f' Fee $10.00
~ per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passpor1s, veteran's benefits, court
proceedings, or settlement of an estate.
~dle)
No;W'
For what purpose is information required?
:CJ) fiA rf(/5P5
In what capacity are you acting?
d'i0~
DOH-301 (3/93)
(P
~!
Name (~lrSt. (Middle)
f L 1-:::--,
~ride ( . ~ L-
Bride's Age
or Date of
Birth
e :esidence ty)
Bride {/( C""';> 5
~::t~=Zme ~C ( ;'/ ..
Used at That Time J ( .. J1 e ) VI
~=a~:S s+ ~h Y1(5 L '(J C
Performed - veT h '
l-f~3
iV1
V\Ihat is your relationship to pe7o&e record is requested?
If self. state "8eIf.- ~ e::.--- (
If anorney: Name and relationship of your client to persons
whose marriage record is required.
o-q. 10
address where ~ is to be sent
C~~~4 M
o / J-5:3J
JUG 2 9 20'1)
TOWN OF WAPPINGER
TOWN CLERK
.,' .,....:'.,:...."'.r,)'...:""
, <
s:D\r~1
.. ~'-~~\J
; .. '. . .'.,
City of Poughkeepsie, New York
Office of Vital Records
POBox300
PoughkeepSie, NY 12602
SS
1~65
Telephone: (845) 451-4200/4203
Fax Number: (845) 451-4239
Monday to Friday
between the hours of 8:30am to 4:00pm
(est-eastem standard time)
**Allfax orders Inust b~ in our office before 2:00pm (est.) Our mail leaves at 3:00pm (est.)**
Application for Transcript of Marriage Record
$10 FEE REQUIRED. FOR EACH TRANSCRIPT REQUESTED, PAYABLE BY CASH, MONEY
ORDER, CERTIFIED CHECK, OR VISAlMASTERCARD
WE DO NOT ACCEPT PERSONAL CHECKS
Today's Date
~ /:</~/o
f!11'chu.EL
tJJn , y
to I~ 1hs
I
nt'~AbJk't\J tkck
$~S-(jl. Cl ".ee
Name of Groom:
L f,{V(lf i1 Y
'~Jn1
Maiden Name of Bride:
Date of Marriage:
# ofTrans~ripts requested:
Place of Marriage:
Mi>P-rJ.1J . ch V Abh
Purpose of Request:
Are you the Brid~
Name of Applicant: ~~6jL AtDfL P,^-V '. . .
Address and Telephone: /f!~J... U w h a ckCYl ~(XCJ:.. k~'
, ~
fJ'l9f h ~eep 5"tk: K Y lAb oj
For office use only: I AliI) 02 2010
'~ .
(. : "J ; .,
Year: rO\/VfV 'C~i~~RrNkGER
-,- ,
ffBlE ({;IEUW'IE~
Registration No.
Issued By.
Method of Payment: Cash/Check/Credit
......
..if ----"'
APPLICATION FOR ACCESS TO RECORDS
To: Records Access Officer
Official Use Only
name of unit
address
~~~~~Yl~\Q)
JUl: 2 1 20'i~
~Of WAPPINGE.R
T LERK
,
I HEREBY APPLY TO REVIEW THE fOLL.OWING RECORt:>(S):
1
tYU~~~ 6!fA.e/ :,. ~4 Ib ~~
~L/;~ /./U~ _'--"CP~A
La ru,)'Y}-e..k-
ct-
/k.tlJ m.
name t/ c J r
represetlting
,11 rL' ;/af~
moiling address
.iu f/J ~
I1l"t ;J.
,
1 -;;2 ":? - / L:)
,
wte
f.. Ji" b') If ~ ~ .,- /..::r i- ~
./
telepnone
" r,tJ-tn I? <-I // b .f 9'e>
zip
(for agency use only)
_APPROVED
_t>ENIED (for the reason(s) checked below)
_exempted by state/fc.derol statute _pli'mding contractlbOlrgaining negotiation
_unwarranted Invosicmof privacy .-registered trademark/trade secret
_record(s) part of a:nlnYestigotiol'l _eI'Idangermel'lt to life or safety
_Interagency transmittal/not policy oriented -port of test questions/answers
_computer access code(s) _record not mtlintained by this unit
~ecord of Which this unit is the I~l custodiQtl cannot be found/does not exist,
_other (specify)
Signature
Title
PLEASE TAKE NOTICE
t:>ate
You have the right to Appear (l denial of this application to the RECORDS APPEALS OFFICER. An appeal must be made
WITHIN 3.0 dQys from the date of receipt of the denial and the APPEALS OfFICER must fully e.xpl(\.in the reason(s) for such
denial in writing WITHIN 10 days of receipt of an appeal.
Please mail appeals to:
RECORDS APPEALS OFFICER
Access to records iSflNMded through the New York "Freedom of Information" Low (Public Office:r's Law, Se.dioos 84-90). The law is
c,dmitlistered by the Committee on Open Government In tneDepartment of State, 162 WOShl"9ton Avetll)e. Albany, New York 12231, telephooe
518~ 11<t-2:518.
34
July 23,2010
Village Clerk's Office
Wappingers Falls, NY 12590
To Whom It May Concern:
Enclosed please find the following documents provided for the purpose of receiving a
certified copy of my marriage certificate so that I may obtain a driver's license in the
state of CT:
Application for access to records
Copy of marriage certificate
Copy of NY driver's license
Also enclosed is a money order for $10.
Thank you for your attention to this matter.
Yours truly,
;rid- /;J. ct k~
Helen M. LaFumee
Subscribed and sworn to before me this ;l~ rd day of
n
,20ie,
0'~, ei
I
~ !vi1~
~~4'1 ;::f.03L1C
My Commission Exp. Apr. 3q 2013
,,2i~~"%;:g;;;e;,~::?'}:;;:!,~,,~tr ';;;Z~I;1':r:=~~~3;rJ"f.1~CS~4:''\'.~:L;;;1rf,;~:)%:\'1;:''';;;;n1i:f~\ftiSi!ii2'=-\ .n
7.wu .1, . .....,.... 1,;1
Oiliee ,1 J'IVIt CLerk iter;1
"5 A1aniarr
Cettiticate
;:z eft i~ttatii!lt
f.
;~" ;
}:;;'i
" I
~rj
~ / /)
. :.>'/': ,,' .f.e.~,i. '<'-.J/: ,.k / iE..(
}TOWN CLERK
;
!. .~.,
"-
'-.
k)~.. ,L')..~"f"
\".i
'..;.............;
[.,-,<1
;J
l..i
r"i
vi":
E3':
i'l'~
fjr~
~~'.~.:'i
'i.::'i.::
~; .;
~":'.l.'
W'.~
~t.~
,:,.~
f.,~
:~:,
~...~t.....'.~~..
\"~..;,
L.
t~{~
~:r:
u:
"'1'.
~\!:;
~l~
'-/-:.'
~i
~~
~J'
~i.~~~:.:,:.~~.
~~~;
~"";."~".
!'r~
Ig
Ur4
t':.','.,::::!
l<eco'Cl
/IJo...}~.......
oi {feat...
7/, i.~ c::;Jj
1970
70 Cetlit1!
.......................
..rc.li.!iIl9 "I..
(City & State)
Ne\11 York, New York
Hyde Park, N. Y.
............... .
ILl
Edwin J. 'LaFumee
wit .' botll . May 2'2, 1939
11'".\
(Date)
all" . Helen Marie Todd
wit .' b"'C:II. July 6, 19/+2
wa.!
(Date)
IHattie" "" June 7, 1970
wete
,d
(City & State)
i Hyde Park, New York
tejitf.ill'! al..
(/1..
(City & Slate)
poughkeepsie, New York
(II
(City & State)
Livingston Manor, New York
(Date)
"' ,/"w" b~ iI., ),J~ "~;,I,,,) I;"u" ,,,,I ",i;I;,,", ~I "'"'''"ff' ,(..,;) P""'" 1;1,,( ;" /1.;, .{{;".
:::/),,/ e.t (I l
.~~P.P.t.11g~:rs.r~~g.~, /lI. (II.
}tllle.~,.l ?i'O.
[ ~etli]
Any Alteration Invalidates This Certificate
"sued pursuant t" Section 14-a, Domestic Relations law
!J!'~~~~~~~~~.~~~I~._t3~!mil\.;t~~~!>'lt~)gIT~~t....
VS.12 T (15/66 REV.) (eUI-2B)
<<J,.......,i.....).,..,
C;i)mrnJ.skl1w.::f of M0t('( Vchicle,;
10:231139020
,
1:
DOB:07..()6-42
LAFUMEE,HELEN,M
PO BOX 227
COWMBIAVILLE NY 12050
SEX: F EYES: BL HT: 5-07 CLASS: 0
E: R: B
ISSUED: 06-30-03 EXPIRES: 07-06-11
(I) u ri ~
-,bt I1lj(//v-,;X~
I .
42519380
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
"
Search and
Certification
D Fee$10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Depar1ment, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
~ee$10.00
~ ~r copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
6"
(I
In what capacity are you acting?
(ll) ~- bAAd12
What is your relationship to person whose record is requested?
......- ......S D .~
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Datej.;;?, 10
Nt( Id~()
Please print name and address where record is to be sent
I/o J4-lay'j i<d _
L/JL ~OLt1. V I / I~ tU'I 1;;1 S V
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
.;~~~~:-",",,~:~r:-;m"'r.r~::nr,;,,;;e-..":~-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and ~
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR lYPE
Name (First)
~room jv1 A C CO
Groom's Age
or Date of U '2
Birth I . 'I f2- S
Residence (County)
of '~,
Groom LA)TC'HES'S
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Last)
Vi VANc..Q
(Middle)
A.
-J.AN I G J ~'; I 9G8
(State)
N, 'f "
01-- 2.~- 2/005
For what purpose is information required?
'"0
I A~S PO e..T.
In what capacity are you acting?
~'
\J
I'Q.
l~
~
s~re of Ap,p"
tt&l .
Address of Applicant
~Ocl HvIVkJCSS
- A 1.Y.
t-i s,H/<.i L' 1'-1
/)
~~
/'2S-2. ~
, ~-U~W)
DOH-301 (3/93)
(Middle) (Last)
, \j AlEiJ2UfLA - V .
Name (First)
of '0
Bride !<oS' A
Bride's Age
~~ateof 39 Au 6 ,30T,7 I~ =1-0
Residence nty) (State)
:ride ~"T(HtSS {\J.
If Bride Previously
Married, State Name ~"7 '- 2c::'.- 20 0 ~
Used at That Time U -.J
Place Where
Marriage Was
Performed
..
V\Ihat is your relationship to person whose record is requested?
If self, state -self.- ':~E L (- .
If attorney: Name and relationship of your client to persons
who8e marriage record is required.
0'1- -22 - 10
Please print name and address where record is to be sent
(PLEASE SEE REVERSE IDE)
JUL~ 2 2 2010
TOWN OF WAPPINGER
TOWN CLERK
\I
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Recorcts Section
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certification
O Fee$10.oo
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports. veteran's benefits, court
proceedings, or settlement of an estate.
C\.
(S!Ble)
)J\\,
Name
of
BrideS
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was .
Performed
(Fnt) (Middle)
..f'fN'- ~v~
(Last)
(Middle)
(S~~
vu( ,
5
For what purpose is information required?
.f1-e.d 1- {' Q .1. fk ~uvCvW2W
What is your relationship to ~rson whose record is requested?
If self. state -setr.- '"S~ ~~ '-
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whoSe marriage record is required.
Add1:4~~ . \,
lJqH' foJb J ~\ ~ I ~
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
JI
.."") fl. If..;...... .........'.;...~......'.?a.............. .'.'~
LA'\..[" ,::.~.. I
CO~RCI.Att. .
~ fl,IVi~R""'rraNiS E',
. ~
/
,.
j'
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriage Record
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names ot
the contracting parties, their residence at the time the r
was issued as well as date and place ot birth of th n e andrc::
groom. ~ \.s;
A Certification may be used as proof that a
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes allot the items of information
occurring on the ori. record ot the marriage.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) _
~room -V (\#A~ 1> - rJ' l-'lv.#~J
Groom's Age ! I
~~ateot ~ ~4 lj)~
Residence (County)
~room j) VI. .,~ J{ (=.f.r
Date of Marriage /, I.
~ =hCovered ~ / J II) 7
Place Where
~=wasvJAq~//V<OC~
(State)
/VI
For what purpose is information required?
~/jf) ~Orr
In what capacity are you acting?
Name (FIrSt)
~tride .s' '1 fA.#'
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle) (Last)
rf c A/Nt: rr
J7S/
.r 1)1-. \NeZ L
~'N#' ~<I'1<4/1~fJ"/~
What is your relationship ~rson whose record is requested?
Itself.stale-self.- f t:'l.r
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Address of Applicant
DOH-301 (3/93)
Date
7 J)
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
.~
..
;
/
.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
_...."i'..:.~ ,>>".~::,'x:::~:~:?L~} ,:..~.~o;."-"j.--:.:-..:::y.%,,~< ..."Xy-'<;x:........::::<<~:.;:::ili.,............"9I::;P::'(....{... ".......... .. ".,C<<" ...,:;. .;,.;..X%..-:.,:.-"...<<.......x. .j." "<<~~y<<.:-N :. "x1Jill::7.:'~~:'~_
;;A~t;;J;.l;ill0;,};~::.,<;;."v;>;,~;;:, v ...:~/~ ,.~\:^.;.:~;<, :...^~;,<,:.:".:~.M ':~K.::~. <N~ ...:..~.:.,<:<:<"vt;;:$W witZ. 1
(State)
Awhat purpose is information required?
~~ LJ/') r -t
f
In what capacity are you acting?
II
Name
of
Bride
Bride's Age
or Date of
Birth
~esidf" /J~I ~~~ 51-,
Bri~a.-- I/J .-!iI
If Bride P
Married, State N
Used at That Time
Place Where
Marriage Was.e::;. . \ I
Performed <:..If. 1i11f!e; J C~t:-h
(State)
What is your relationship to person whose record is requested?
If self, s~::t.t .
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
~.
/
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coe.,v of Marriage Record
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
r:t'l Fee $10.00
lLlJ per copy
A Certified Transcript includes all of the items of information
occurring on the original .
A Certified Transcript ma be ~~rW~\D)
parentage and certain othe de~~~ may be
required such as: passpo , veteran's benefits, cOurt
proceedings, or settlement an estate. JUL 06 2010
(Middle) (Last)
Set.
(County) (State)
uP
For what pu~ is information required?
(firP()fLr-
In what capocity .... f#.
Name (First)
of
Bride W c:/ ,
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Stale)
(Middle)
(Last)
f;;--
tvrl-Pf/0/ <0 t:12-
_..yaw ~whooe""""__
If self, state -self.-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
__WW_t~~lj~rWf;;iJ;~S11f&~f:';{~ft~~~}~:~r;~i:.: 'f~::':">~'< ~.:: ::. '. '.. ;~~~... :";..:~,~\:-.::~" :.. \:: ~~:"~, .:'~;':..l'~'~~~;f?~~a~~\i:~~tRti8111Kt{~1I
~W%r::~f@..~>>,.',::>>:::,:{::-" ;."X:-~tY.~.:-::".t%.':.:%'::"::"",::: '::~;'...-:,w;>...>:.:v.,,:"'S-'... ... ~. {> ^. .... . . ^. ,,-:"'X .::;-.:-:-.: ...../.... .. ...;....~... ..;."..;.,.....:-(~::.:::<<:..:=.:~.%.:.:.;./"~~..:<<-:*m:$:::.:OO~$>>l.
;:~6 r!t7tH~~. g I)
~, I~> 0
DOH-301 (3/93)
Date
7 6~ 0
Please print name and address where record is to be sent
(PLEASE SeE REVERSE SIDE)
.. .
/
, From:
- '.
..
NEW YORK STATE DEPARTMENT OF HEAllH
Vita! Records SedIon
07/07f2010 12:45
#427 P.002f002
'1
Application to Town/City Clerk
for CoeY of Marriage Record
~i;~;~;:;1~~:r~~*~~~"~~1' :- ~ ~_ ' ~ _ - ~';~~J_~,'_, \ ". v~~, ' , ~. '~. r \ . - ~"':;'~ :.'. '.' 1 - ~: .~i', .:~::~:~~
Search and
CertiIication
O Fee$10.00
per copy
A Cerftcatian. an abs1nIct from the marriage record iuued
under the __ of the HeIIIth Department. includes ht names of
the contracting parties.1heIr residence at the line 1he Iicen8e
was issued 88 W8II _ daII8 .-1d pIKe of bi1h of !he bride 8nd
groom.
A Cer1itication may be used _proof 1hat a IYIaITiI9 OCXlUn'ecl
s..d1 and
Cer1iIed Copy
D Fee$10.00
per copy
A Certified Transcript includes III of the items of information
occurring on the original record of the marrl&ge.
A c.tiIed Transcript may be needed where proof of
plWen1age end certain oIher dlItaiIed inbmIlIicn may be
Alq\Rdeuch as: ~ ~'8 benefifB. court
P~. or aefllemenl of... 88bd8.
":::<":",. ,/,~',' :": ..". '..... . ..:. ~..: ..............~~,.:.."..~'.....~~....,,~:t~~.~~:
(latO .
01 S~-i' ~
,
-.-' J
~ \ .) f
V L..d
Name
of
Bride
Bride" Age
or Date of
Bi1h
Reeid8nce (County) 0'" C .10:;':-
:ride 0 -{ Ct A ..e
If Bride Previou8Iy
M...ned. SIaIe Name
Ueed at That Tune
PI8ce Where
Marriage W.
Perbmed
(Fat) (Middle)
\.-Ct It t ~ A-r~ V\
\?-- I d~/bq
(last) I
Yli \)
(Stare) N
FL
For whBl purpose .. infot'1nUon required?
C,,~" b;1 J!Y1 [V(~ C"'--\' Bc,,+e
()CJ,~1 y\~ \ \2- ~
In what capecity ... you acling? If aIIDmey: N8ne... reIatioIllIt1Ip of your dient 10 persona
WhOlIe I\.mege record .. required.
Addreaa of Appicant . '\.
f 3CaCo CSffe_yluCZY
,A-v:::.p~q I r--~-~ 3:i7 J ;)--> ~ \1 1__", 111/ f) ,J u~ L .
s., , ~ ---.-~E\..~ , <LJ._
SlJIIQIMBQIt'W)/o SWORN 10 . 5['0 -ey: v' l r-\, f (l.......H.,.u.\"
:~~MEIIlLS--J~~~. (PLEASE SEE REVERSE SIDE) j I\, l/)'\vQ! 'j U 1br J<{",,- I
NOTA ' , ~u; :.....~.~ K'MBERLY ANN NUTE
__PERSONALLY Ki'fOWN, {'!(~B MY COMMISSION # 00728942
9R~CED ID..+-L. ~~l..{ ~r----~ :\~: eXPIRES October 25, 2011
Lc.....'-'--\~ C t. _ ~ -n t -e ~ (407) 3ge-0153 t<oridaNoi;lfy$eNlce.cam
.r"" ~lR
re(~..\-l.t'I\(' o~, ,t\"'() II~\ 1')~" ! .~). t'
"'"-"' ,\ l '- ~ _ \...-. L . f.L...() 0/,Q . 0
~ t'-.J -'-J
.......)./ ~/ / ;:'-')
'f ,11...../
o\.~'V\ req. u~<;+z t!4 ~
[I ~)
nJl\lV 'I',fj a V r t rr I? L . (I + ---,
I vrL t' I j-G C ep1 r ;-, CCi, :e f --'-
I
~ From:
;.r
-T
_.J-.c]
,-- f . (
~t7 I-C\
I
L qc{ cr4
(' '~p.''-J'
~ ......J "
-......../ .
. ,
of
qb 0 r€~0-QS~r'j 1i"~
() '^.I' L
i)+-- r\I' I
v \ l J l Qf ('.'ctG \/1 0 (.p f () C-ic f;,-{
\ J v~ v \"-- Ii:::) I:::: ~ \..:,
, f '
~ / \ \ <: J f' ., i
1'\'( Vnoer' '\.\{ --ro-lJn' "ch
1 <...J \ '-... ~ ! l 0 I!
J
"'II f/\(\
.j'\V! '
07/07/2010 12:45
#427 P,001/002
rf)r\\. \J.i \V1 i' ~AL f D /~ f." ~ ~
If l . \ \'-L. '-~) I, ~
+h
v
C '\. -Lr; /'
,:J I.) f ~l' I
'--' J
{y\ 'i
I
_______m ~
J 1~ L .
( vfl( 6[.-11 1--_ /'rY~'{~/
v
1 n
~I ~)i&
J/}.I -: rrl
c;t-P~1Y1 _ :_/ './ / ),
G~[h -H<:~ +ra i/\- 0 -P Rdeor~.e
;!7!1{J
CH'V\ re~~s-b ~J CL
cer-+i t2-icAJ.e I T
. ----'
(Y\~ \li-k~ ~c0vd
+D m ~ S l.s+<-Q(j
.. From:
I
]
L qct(J{{ std-e)
rfly VnttV{ (5-€-
I
COr{
of
07/07/2010 12:54
#428 P.001/00l
C\ \s 0 r -e b 0QS ~ r::J <~
Zl f- ()1 Q( (I,~ k (-e (", c~ <<d
K (mb-er 'f Stei+n t'sch I
\ try)
U4:41lftMr
~
STATE O'=i~ORIDA C INT\' ~. '2L
ON THIS D~.x. o~oy~ ?oFf ./fC-
APPEARED 1aJH.A S~o- I'ERSONAUY
~~:~~':SE ~AI\IE(S) rSl~:;' s1~~
EDGEDTIfATH~~~E~:i~A .....
FOR)HE PURPOSES mEREIN E SAM
v:aSONALU' K.~ NOTARY i&~
__PRODUCED ID - t:lJJl2.l!L
,)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CoeY of Marriage Record
Search and D
Certification Fee $10.00
per copy
A Certification. an abstract from the marriage record issued
under the seal of the Health DepaJ1ment. includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits. court
proceedings, or settlement of an estate.
(Middle)
t)
O~;>~
Name
of
(Middle)
L
(Last)
" <';) '::>
(State)
/VY
For what PUF is info"}/on ;r.ired?
)..OJ.j- f1~r I ~fc<-'rI---.fJ.
.
V\Ihat is your relationship to person whose record is requested?
If self, state -self: .
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Ad ApplicanY .
:J 5' ,IV/c/Mv'r ,1&/
jv~)-Irf hili ",.,(
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CO(!Y of Marriage Record
Search and ~
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
_~f}Kfp:{:Hp%F'j1f~:""r~<~t~~7""~~'f'V::~':~<~', ">>:': " '/::< '<<~'1:<:<<0: ::~;r1('~*':HY'<%i~lliffi%1)W@11._~
~<<;..,<}m$:~.y/......#.A ~.};x.:<%:<<.:~/..?".....::M:~>>--.:,":(.x""'''':-,'''' <<-:it>>:.,....>: ..V'.:--.... ;;;..... ......:....::xH........... .:~:p-..;>:.:-..:...:;:::y.:::.-.:>>;;.....::.>>.. ..:-;"x-: -:...i.-::-:;...~~;W... '.~~*:x..~=>>::,., ~
@:W'<..<.<W_~l::x~~~>>:.->..-:~........->..:-...: ...W.y.........:-............:~? . .....:-........ ......;: ....y. ........... "...." . . d. ," ... .....x......~.>...0...X....... .....<=....,:<<.:::...........:'I,.;.m:-;:-::....<::..::........:..*...~~~:;::-:w~.>.::&.....~~~:.{.......'U:::':
mffi@~b_~ww.:*rtk:~l(!;'}:J;~f.JMZirp:.d&~:iiY;j:H: ~ 1. : :~.: '?'t'.. . ~ .":: ::::;. ';.':<, :t/')t..~?;.~:;.;ri.~1~:;:7i~~.'-Yj~~;ft:Y~~$70,;ril.0tti_t
PLEASE PRINT OR TYPE
Name (First) (Middle)
of
Groom
Groom's Age (0 0 (-L{{
or Date of
Birth
Residence
of
Groom U\C'^r'~
Date of Marriage I
~~:Covered ~ l yl 90
Place Where
Ucense Was
Issued
For what purpose is information required?
toe t c....' ; -e C'-.) -n-1:'/
I
In what capacity are you acting? /'
~ <;--e \~
Name (FIl'St) (Middle)
of ""'
Bride \
Bride's Age
or Date of
Birth
Residence
:ride L{. -\-C ""-Z ~ ~
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(6~
f'
What is your relationship to person whose record is requested?
If self, state "self.. '
<;-e l.f
If attorney: Name and relationship of your client to persons
whose marriage record is required.
c; V\J- C{ t--J L--~ ~
~ ('( (~.\" f z ~C/2
DOH-301 (3/93)
(p
Please print name and address where record is to be sent
~~~~~~~[Q)
(PLEASE SEE REVERSE 81 E) J U N 2' 5 2010
TOWN OF WAPPINGER
TOWN CLERK
NliW.Y();
-~:!~
fO$M.N_
/
'V
7
~.
'\
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
_N'>>x-Z,..-::V::...X.:s;..... ...... 'w'''''' "''''Y'~''%'''' ....v~......<<'-~. "'".........::;.. %....... ..... . .... "->:'<6. .....>>>~... ..->>.....:.;..:-....~....n';>..JY.. .r>...:.:~~~.x<:*.fu~l~~t
rig~llig:tib21~.1JL~:.<; .l~.f~~;i ..:;,'.;;;' {' ,,:'..'~ ':;.~.,~: ..;, ,:,"vt~~,:v.:~,.~::...<....~::~~;:.,;::L&':Jlkt&)DWii.$.\tXt~~
PLEASE PRINT OR TYPE
Name (First)
of (',
Groom
Groom's Age
or Date of
Birth
Aesidence
of
Groom
Date of Marriage
or Period Covered
Search
Place Where
Ucense Was
Issued
(Middle)
J.
D
---/
(Slate)
kh~5S r
Se t. d D i ) 9 f{1a
(County)
Name (Fm)
of 1/
S Bride n (l
Bride's Age
or Date of
Birth
Residence (County)
:ride Du.;
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
What is your relationship to person whose record is requested?
If self, ~~ (';:: .
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
/
~
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
~_Ifdi;):f~lt~i}ii~iii.~::;l:~~'> ~:~:;[;;:::::::':'~':~, .......,:.:.~.7:. .... '.. ::" .:~. <.; ,::~::~...~.:": <....:;::;::::::~t:.",td;;~Xi;,iijt~$$1~i~i(t;;til~z~t~~li1i
Search and
Certification
Search and
Certified Copy
~
~
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of .
groom. t a@ ~ ~OCC~U~edVJ.
A Certification may be used as proof ~ ".
[] Fee$10.oo
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Transcript may be needed where proof of
certain other detailed information may be
h as: passports, veteran's benefits, court
, or settlement of an estate.
(State)
(Last) Name
~oh~~I)I'~ :ride
Bride's Age
:~ateof JO(d--/lq~tj
~esidence \... (County)
Bride D vet -e S 5
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(First)
(Middle)
(Last)
h~
(State)
e.w Yo(()t..
~
For what purpose is information required?
~1\cAi'cL
What is your relationship to person whose record is requested?
If self, state "seIf.- ~ ~ I ~
In what capacity are you acting?
-+oIL ,-~(l ----IF
If attorney: Name and relationship of your client to persons
whose marriage record is required.
---
~
li;;m_riiw_;~1':;:::~:;:;:;;::::::::r::;":/'~>n1<;\.:::.; :'~:-.: .:..::":~:;\':. ',. .' .. . .:. ..... :),. ..: .. ..': ,.:"j::::;".~\' : . ..,t~C '0t~;~J:~j;::;i\:iL~~t::::i:i!:~f;~'?jll
Date
IJ~qD
i)
Please print n e and address ~re r~ is to be ~l
J1..olYla~ 11-. v&,/+)/)" a f2..
-.gcr (2ob,'nso(\ WI
W }J.51 i)
DOH-301 (3/93)
(PLEASE seE REVERSE SIDE)
/
fIJ
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' of Marriage Record
Search and 0
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
rvl Fee $10.00
~ per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed infonnation may be
required such as: passports, veteran's benefils, court
proceedings, or settlement of an estate.
~~:;~1if!i~;;:I~;:'(:::;~;;,~ <::,~,:,;;,,::;~:~~;t,;(~~~L,>',,~ :\:; 3::. ,:': ~'>: -:..."~, _' _' ~,'.~ :,;'":''' .'~".::' :':' ~,:.:':i:?';~,:';~T~!lt~';j;;';~'~:~~;~\~:II~i_~~
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age \
:~ateof d \ ~ \ ~ d-
Residence
of (I
Groom \-0 0 'L
Date of Marriage
or Period Covered
Search
Place Where U
Ucense Was C\
Issued
(Middle)
(Last)
ll.\LQ...
(County)
(State)
IL
8 \ d \ \ \ q~ ~
\ \~ \5 9
Residence ""- (County)
:ride \ 2) u,1- c.. ~ 'to <) j
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was \" \ \ . .
Performed r \"~ f\ ~, \\
(State)
I\\..
For what purpose is information required?
~~ ~ \ ().l ~ 'l\Q\'-+
'\uD~ ~OY" 'If\<su,\()..V\tQ
In what capacity are you acting?
VVhat is your relationship to person whose record is requested?
If self, state "self.. '
, S It\ t
If attorney: Name and relationship of your client to persons
whose marriage record is required.
re of.APPlicant A 1\
,-^~/~l/
of Applicant
\LsS lXY\(i~\O-V'lt
~'\~ -S\~u) Il U()CJbu
lo-'\ \ - \0
Please print name and address where record is to be senl
Jv.c.\\.-\-~ ~ Q. \ \
\U0 ~C\\\t\V'd G
G (' ~ <s \ ()....\~ ""T L (p 0 () '1 D
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
-
II
iI
;I
.....
i!ii
II
5&
!!
II
!!i
g
!.!i
:=
t:,<....
matS AlfGAl. OOCUMENT UNDfi.RnlEi UNIFOiW .
~TCNICAL (Wt ACT Of' ~ lAWS .
t.1...,.~=""-IO~~~~~Jriy-dIafl i
00.,"- -,,-- ..
_.___....__.--.--- I
I
I
I
I
I
""'U..
"'-,
--
AI!_
"":.......
.~ ",:. ~ ~ .,::' '1; ~o-".~ )d '..,,) ~\.\.(. ':"u I
.':c~';\i'.'" \, ;>" i''j' ;.14'"'~~''''' ,-;.",.
1:~/~<~ /' ;:." (<If' :{J!0\0I~""1~',,"r~~~..r 'I ~'7 j /''-"'
'-d y\1. .."} .. ~ A.~";'<A _.~ ,< "jl . "'a I.
#t,{l :1t-.;-,:\= l~ ~";..A,.~~P"'J '-".l 'r....'\,1~1..., .
;1 . ~10 .. .,).:"/ ('. ........ ... (>'. f' ( 1
....
I
"
...
--r-
Judith M Bell
160 Mallard Ct
Grayslake,IL 60030
June 11,2010
Chris Masterson
Town Clerk
Town of Wappinger
20 Middlebush Rd
Wappingers Falls, NY 12590
I am writing to request three certified copies of my marriage certificate, and I am
requesting the documents in order to provide proof for insurance.
I have enclosed a self-addressed, stamped envelope and a check for $30.00 ($10.00 per
copy).
Thank you for your assistance. I look forward to hearing from you.
Sincerely,
C----",'," \ I , ,\ ' )
~>.~,., ,^~wL
"'~
Judith M Bell
~~
Enclosure
~ \ ~1\'^6 \\.\~~-\-\~ 1"-.~\..L \:.\>R. ""l'-n- n'b- "I'~ ;).
U\ Q..-'i'(' C-~ \ '~ u.d\ ~ - ~ ~ CA. \\ . Y\ Q...'1
c
,.
-----:.'
!
;;::.~d-- NEW YORK STATE DEPARTMENT OF HEALTH
, (j" Vital Records Section
Application to Town/City Clerk
for Coey of Marria~e Record
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health De en , includes the names of
. es, r residence the time the license
~m~ceof 'rthofthebrideand
A Certifi1UN ,~ ~~ as proof
WN OF WAPPINGER
PLEASE PRINT OR TYPE
Name ~First) (Middle)
~room ~O tV
GrOOm'SA~
~~ateofJUNE ?
Residence (County)
of
Groom 5
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Last)
CfJARJ
/9
(Slate)
/ N FL{)f(I/JA
In what capacity are you acting?
Search and
Certified Copy
f\7f Fee $10.00
~ per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an eslate.
Name (First) (Middle)
~fride JUn i-rJ
Bride's Age
Date of
Birth 0 - 1.5
?:dence ~ ~~County)
If Bride Previously
Married, Slate Name '-/ "
Used at That Time V LA IJ
Place Where
Marriage W.
Performed
(Last)
C.IiIX~
What is your relationship to person whose record is requested?
If self, slate "seIf.- 5 E /... F
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Dale '-/ .
\/UNE [? C2LJ/tJ
Please print name and address where record is to be sent
;:JU/J);;J il, CTJ)(J~
J~ It:) l?e)!'NO.l...LJS J?a J.a/~ 3
p~ , c:/
(PLEASE SEE REVERSE SIDE) /Jj)/) /(e ss
dr: of Appli~), ../J
/~/O Ne)V#a~As~~,j6/~E
A 11 * E 1... fJN/J H,.3 3?o/
/
DOH-301 (3/93)
..
,
"
.
.
fjWJu.J <€' ~ / ()
'---r; LJI/orr; ;#;S tr)7Jy{);./cem:
X :::( f.,U)/7// Ii Ci! 7? IU / T'Mj tV ~;;; if ~
t<eff~es/ f} CoP!, ()~/Y)( m:t9If;e/1J~
jlceAf5t=. k JtJlliV v' C/J~10 aN Dec,
, f
----.LQ, /9f? 7. _ mil NfillJ~/U ~1iI/cS ---
, ~ ~ I
!Y} Iff( R I?J t:... tV IT S ---J tuJ I~ ,IJ, ;J es () -<./1, ,
~. .--/
Ide. X?e79so~ f:'o~ 711~-s 'l?EJa&.5~ /6
/!;Jecl7u<Se- NOW Xy?C's/oe.. /N aa/f'/LJ/T Y-
j /
. .i
/=')ORj,{J/} IIl'ls New J..:I9/VS //\/ o;eD~ "'7;)
. J I
l<e,NeuJ ,You~ .L?x?/ve~s )I(I;/Vse ,~<<-
W/~L ;..reeb IJ}'TlPX2/?9-,y'G )./CeAlse 6/~///
C C?-x?'--J/ )::/ C ;-tIC / s 5 .# v j:JY;; () {)"c () j:: lo./J)'{Je 55
NOW/
*<Jd tJa WI(f r~ ~ StVlL ~~ ~
2o/D Ln <ib(~ (b1U1.~ ~ol ~ ~u..JdTA. .
A. C O)(Y' hD rprt>c)zk.f 1= Lbl- ~ ld~r:b~
\.
<z-W
'UISV lJIION IIUO!lIN ~GnOJIlJ. pepu08 ","J""'t.
~~"\::II:IO ~#,-
OU&86 00 " UO!SS!WWO::l lFm~~~
.~oZ'U lInv SBJ!dx3 'WWO::l AW ;. · .:
IPIJOI:lIO elllS . 311qnd AJIION \q.~ · ~i
0131:1 'r NMVO .."t~t,t;~~'"
A/K)fh;<'J;Y
c? CaA/L
!3:NCJ, OSe6/ ~~ WILL r/N~ 0/ ~c)/()O //), (),
f~m'~~'~~~\ Notary ~u~~~ .Jsr~;eL~f Florida ~
4 ;' .'~ My Comm. Expires Aug 11. 2014
~~-'$ ,E>~ Commission" DO 983110
4 "'1" OF f~~''''
"...... Bonded Through National Notary Assn.
~
--., f
-t-\
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
(Middle)
r
1 /~&, ~-
(State)
'P V ~ t-1s N'I
:1~;c:;=r
,
In - """""' are Z
tI"'~ te-v
(Middlel (Last)
,COt lJ e { To r&J
Name (Fnt)
of ,--
Bride ..j e ~
Bride's Age
:~ate of 6/1 / :1(. ( It(
Residence (County)
:ride .J"~ --C
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(State)
What is your relationship to person whose record is requested?
If self, state "self" .
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
~"
., ,I,,',
_,j, 't: f
t .I" ~~'. ~: __.~11 .~
,._.,~~''''''''''''"'''''~,~..".....__~.__-'"'---- ~ ..7
/
,/
..
;
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Search and 0
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
_~ ~ Fee $10.00
,q LJ per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or seUlement of an estate.
_f1,;ti;tI~'t.'r!;i~~)(:~ ;?f>' "<;":::'>;:'?,"""~~\ ,:<,~,,<:: ",", ',", ~;",""" <t'<<~""': ~:<~~" ~'<-"<<"::ti(~::~,'fii_~i~t~l~._~
M:s:::s>,:<<~",,~':-..d... ... W ^,,~.::;:..~.-:....-:...-:-:-...; ......:;. . .../-:...... . ....B.::; .. .1'....... x. ................. ....x ..... N............... v,' .", ...... :-. ....,. /:-.:<... W W >...<<.X:>>..J>>.tO'M'$.~ ...:-
PLEASE PRINT OR TYPE
Name (First)
:room .--" () n
Groom's Age
:~eof (y ~~ ro I
Residence (County) (State)
:room ~U~}j
Date of Marriage
or Period Covered \ A
Search \ v l
Place Where
Ucense Was
Issued
For what purpose is information required?
Name (FIrSt) (Middle) (Last)
:ride ULno \~ l\-N N lC?c
Bride's Age
::mof II 9 ~3
Residence (County)
:ride '--:bu--tcDe~5
If Bride Previously
Married, State Name
Used at That Time
Place Where
~=~Was j) U k1
(State)
~
'Nhat is your relationship to person whose record is requested?
If self, state "seIf.- .
~f
In what capacity are you acting? If attorney: Name and relationship of your client to persons
whose marriage record is required.
Add/58AV~ N~~ad I20Y
IUa;2j/Z I Z)7(J 1Ri~(G~llW~1DJ
DOH-301 (3/93)
JUN 082010
TO~~WOF WAPPINGER
N CLERK
(PLEASE SEE REVERSE SIDE)
f
/
EPA~~~lQ)
Search and
Certification
TOWN OF WfWf!JNGiao
TOWN ~~py
A Certification, an
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
d Fee $10.00
t6J percopy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or setllement of an estate.
~.k~li;5t~MtJ~;2f2.~;:::~>';,;(::~!;t::'::::~::,':~::'::~;;,::':~x:,:",::~:~',..:~~.;i:::.:~:.~::.~.:~:::::j:3{f;~,:j_;[~i_~
(Middle)
(Last)
(County)
(State)
~i
01
~a ~0r\
In what capacity are you acting?
Name (FII'St) (Middle)
of
Bride
~~~ ~ ~LfI7>L/
Birth
Residence (County)
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
(State)
\
What is your relationship to person whose record is requested?
If self, state "self: - . Q-r I +
he LA ("::0 Ill..
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
:) c9.~ llO
Please print name and address where record is to be sent
cAA~
~&'1
~" fY\a..A"1?
-Wnw\ (J~
(PLEASE SEE REVERSE SIDE)
.
/
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
"
;r Ii
Search and
Certification
O Fee $10.00
per copy
A Certification. an abstract from the marriage record issued
under the seal of the Health Department. includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports. veteran's benefits, court
proceedings. or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle)
of
Groom
Groom's Age
or Date of
Birth
Residence (County)
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Last)
Name (First) (Middle)
of
Bride
Bride's Age
or Date of
Birth
Residence (County)
of
Bride
If Bride Previously
Married. State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
(State)
(State)
What is your relationship to person whose record is requested?
If self, state "self" .
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Address of Applicant
Please print name and address where record is to be sent
DOH-301 (3/93)
(PLEASE SeE REVERSE SIDE)
/
, .
N~YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CoeY of Marriage Record
Search and ~
' . Fee $10.00
Certification
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy Fee $10.
A Certified T nscri~~~e tems ~l::a 'on
occurring on original record of the marriage.
ript may YA'UJ) ~J~ proof of
rtain other detai.!!K1 i~l'P!~
required such : ~N ~traW ~tI#,'tl;lJltf'
proceedings, or lmernilfOV'm~LERK
PLEASE PRINT OR TYPE
Name (First)
of
Groom f"tATTl-\--E:.w
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
UcenseWas 'vJA pp JN~5 fA-LLS1 NY
Issued
(Middle)
\3 L 1"")...\
(Last)
4.t:.M I tV fs- wA Y
(Last) Name (First)
1\ of .
I-1LJ~U"\ S C'IV Bride .:J\ L.-L, AN
Bride's Age
or Date of
Birth
Residence
of
Bride ""D vr( Ht. ~ 5
If Bride Previously
Married. State Name
Used at That Time
Place Where .F II!.. & T f>e t..S 6Y'-,.c 1</ AN
~:::::as C l+vtec I...J Gf- WA./JPIN6beS fAL.LS
(Middle)
"DA'-.J lO
oll'l )(q,f;;,
(State)
NY
lO!09!,QQQ
(County)
''P v T( 1-\-6 ~ .s
o fo / a~
(County)
(State)
NY
l '1' '7 c..
For what purpose is information required?
A ^' N V L- L MbvT'
What is your relationship to person whose record is requested?
If self, state .seIf: S' t.. L F
In what capacity are you acting?
Address f Applicant L ANt:...
<3 ~ c. A-R.. 0 I 'VA L
f\,fAub-An;L\<:.) L'\ Qb/")Q
DOH-301 (3/93)
If attorney: Name and relationship of your client to persons
whose marriage record is required.
~o -IV\AY -~C) 10
Please print name and address where record is to be sent
NA TT\~ -.,.../ A c. /.3 k ISO tV
3f cAe.O I"-IA<...... LN4:-
tV A-'V GA "\uL ~ J L '\ 06 ") ") a
(PLEASE SEE REVERSE SIDE)
"
..