2006
.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for ColD' of Marriage Record
................... . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . .!!.!.i.:!::illl!:.:.:!::I:IIII:I=".III~IIQ.::!tl_liIH~:..i..!:::::.::.::.:. ........................
.................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ............. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . ................................... ........................ ..
.................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . ................................... ................................................
.................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
...,............... ................................... ........................
.................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .................
................... ................................... ..
.................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..
................... ...................................
................... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... :.:.:.;...:.:.;.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.;.
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.. ............................ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................. . ....... ..... ... .. .............................. .
.. ....................
Search and D Fee $1 0.00 Search and 0 $1
Certification Certified Copy Fee 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marnage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marnage occurred. proceedings, or settlement of an estate.
..............................
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. . . . . . . . . . . . .. ., ..
.... .. ........... ......
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.i.!.:!::::lolllillllllll::::IIII:.!.III:::.I:III:III::i:i:
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...................... .................
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits.
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was -r:
Issued I 01)) n
(Middle)
(Last)
Se<wrd S
(State)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride D (,(
If Bride Previously
Married, State Name It \ .
Used at That Time LY
Place Where
Marriage Was
Performed
(First)
o V \.5
(Last)
LOLVl <...-.
ClVl {.C
g d-.O { to
(County)
D lAtLJ1 ( S. S
(State)
ss
For what purpose is information required?
:) nc{ Q1-<u r~
What is your relationship to person whose record is requested?
If self, state "self."
'YJ (f
In what capacity are you acting?
.W --H1 <. Cruu- ch
If attorney: Name and relationship of your client to persons
whose marriage record is required.
~
)t ~ I1tt/ t
DOH-301 (3/93)
VS-34M
(PLEASE SEE REVERSE SIDE)
(
~;):;~',>;,~:!~~ IJltlVER l~ICENSE,
10:243311156
D08:08-25-14
LEBLANC,CRISTY,JOY
2 JEFFERSON AD
POUGHKEEPSIE NY 12603
, SEX: F EYES: BR . HT: 5-04 CLASS: 0
E: R:
ISSUED: 11-17-04 EXPIRES: 08-25-12
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coe,y of Marriage Record
Search and D Fee $10.00 Search and ~ee$10.00
Certification Certified Copy
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of f
Groom }-)
Groom's Age
or Oat
Birth
Residen e
~room d- \
Date of Marriage
or Period Covered
b Search
Place Where---'
License Was r 0 OJ N
Issued
(Middle) (Last)
~a. '" ~
~()
C' ~.O v-cl
If se51\~'f"
In what capacity are you acting?
\,J Cry-.-\.
If attorney: Name and relationship of your client to persons
~~~d is required.
DOH-301 (3/93)
\ r{\ Date
~~ I'). I~ ()~
Address O\APPlicant . _ ~ Please pri
0, (Y\.~Wc)Oq, L
~ '- ~U d-0Jl 'P; c K.:-Lf
J /1 '"
(PLEASE SEE REVERSE SIDE) JLl(!l-"-fl -"'<<1 J( ..s
and address where record is to be sent.
n
\- ou
l ~'--~
.
1~J. _gDt.{::L
------
.
NEWYORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' of Marriage Record
Search and D Fee $1 0.00 Search and ~ $1
Certification Certified Copy Fee 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (First) (Middle) (Last)
of of ---r-l (;..", , \ 'f'
Groom ~ ~ " \ \ \ ~ u n I '-S V()Jja I] e. L Bride v\\'\ VYl ( (\
Groom's Age Bride's Age
or Date of 7- or Date of 3 ~ 3 ~ l ")
I Ll 0 -
Birth - - Birth
Residence (County) (State) Residence (County) (State)
of - -~\C\'\ of ?
Groom e ~ ~ (\J '-f Bride ~ \'L\.. \ ~.,- \)0 \.j
Date of Marriage If Bride Previously I
or Period Covered 'f) ~ 9 Married, State Name
by Search - t - 5 Used at That Time
Place Where Place Where
Ucense Was ~~ \0 , ,\Ci -eA\~ S Marriage Was ..- ~ \'t Ie '-I
Issued " Performed \t. l ( I , rV
For what purpose is information required? What IS your relationship to person whose record IS requested?
C/ ~ \ ~ y~'\ G C \-t If self, state "self." ~ e... t~
I. ~ IJ.. 'C Yj
In what capacity are you acting? If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applican~./ , Date
....... ~ ~-O Co
--=--..:-/ /,?/J7C\.- L I - d.
Address of Applicant U Please print name and address where record is to be sent.
'~'1 G""dLQ '-IV\. Ct I \ ~. d
(, 0 \ 6 S~ \' \ ~ V\J "-I
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section, Genealogy Unit
P.O. Box 2602
Albany, New York 12220-2602
k:6 /1-0(0-0 '" ftL 'o?c:; t/V
~ .A.t~
General Information and Applicatiori ?l7TV
For Genealogical Services _
..
VITAL RECORDS COPIES CANNO.T BE PROVIDED FOR COMMERCIAL PURPOSES.
1. FEE - $22.00 includes search and uncertified copy or notification of no record.
2. Original records of births and marriages for the entire staW begin with 1881, deaths begin with 1880, EXCEPT for records filed in Albany,
Buffalo and Yonkers prior to 1914. Applications for these Cities should be made directly to the local office.
3. The New York State Department of Health does not have New York City records except for births occurring in Queens and Richmond
counties for the years 1881 through 1897..
4. Please read the Administrative Rule Summary on the reverse side of this sheet which specifies years available for genealogical research.
To insure a complete search', provide as much information as possible.
Please complete the applicable section for each type of record requested: birth, death or marriage.
State File
Number
State File
Number
Age at Death
For what purpose is information required? G.A;"'~A~; ~
What is your relationship to person whose record is'~equested? ~.I. 6MJ.4.I-
In what capacity are you acting?: ~ ~
SIGNATURE OF APPLI ANT
Address / *' ANtitJ
DATE
11t.r~~
tf/. &$0
)C 1.0 3
/lJ/&
Send record to: (please print)
Name VAMes ~ ~U1'AtftIM-7'61f!-"
Address I 90 ~t7~'4 A;4f;
City aMt.f4ll. State 11
DOH-1562(p) (09/2004)
Zip Code 1'2.$18
Phone
If req esting birth and marriage records, please sign the following
statement:
To the best of my knowledge, the person(s) named in the application
aredec~ t: C't.u.v~~
SI A TURE OF APPLICANT
Page 2 of 2
"~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriage Record
Search and D Fee $1 Search and D
Certification 0.00 Certified Copy Fee $1 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (First) (Middle) (Last)
of - &"MiZ..i of Cl 1- K C'"6A ~\ A
Groom t.:::b WM2..D f3 N f'J A Bride \v D'i , ~
Groom's Age Bride's Age
or Date of 0 8 I 3 0 I '1" s or Date of 0.7 ( 2~ I ~ 0
Birth Birth
Residence (County) (State) Residence (County) (State)
of Yaoqh ~ N 'i of ~ oSd1 ~'5~ j0 Y
Groom ) e Bride
Date of Marriage If Bride Previously
or Period Covered 0 S- I z 1 / 0 ~ Married, State Name \r-.J / A
by Search Used at That Time
Place Where Place Where
Ucense Was lu ~ N6)~.2:. ~W--C\ ~ \, Marriage Was
Issued ) Performed
For what purpose IS information required? What is your relationship to person whose record is requested?
"\~qS'S 1- .J/Ct cho Cw ( ,+1 If self, state "self." 'Sc:. It
<? ~ YY\Jl V"lJ f(
In what capacity are you acting? If attorney: Name and relationship of your client to persons
~ "::>"ta r1d whose marriage record IS required.
W/A
r
Signature of Applicant /)1~a~/ra Date
~c ~f2D I ) I 2 1 I 0 G,
Address of Applicant '--" Please print name and address where record is to be sent.
Z 7 I \J c;o () t-n ~ U'" , + H 1-
~ U3 h ~ I e N Y \ 2.G 0 I
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
.
Page 1 of 1
Sandy Kosakowski
From: Sandy Kosakowski [smk@townofwappinger.us]
Sent: Wednesday, October 18, 200612:16 PM
To: 'Iiz.kalman@jetblue.com'
Subject: Marriage License Information
Getting Married in New York State information.
A couple who intends to be married in NYS MUST apply in person for a marriage license to any town or city clerk
in the state. No blank forms can be sent or given out. The information is entered into the computer from
information you provide and you are issued a completed, signed and sealed marriage license before you leave.
The marriage ceremony may not take place within 24 hours from the time the license was issued.
A marriage license is valid for 60 days, beginning the day after it is issued.
The fee is $40.00 - cash or check only. The fee includes the issuance of a Certificate of Marriage after you are
married. This certificate is automatically sent by the Town Clerk's office to you within several days after the
completed license is returned by the officiant.
No premarital examination or blood test is required.
Both applicants must be 18 years of age or older.
Two forms of Age and Identity are required. One from #1 and one from #2
1) Birth Certificate or Baptismal Record AND
2) Driver's License or Passport
Previous marriages: A copy of the Decree of Divorce or a Dissolution of Marriage papers must be furnished for
ALL DIVORCES.
Birth certificates and divorce papers must be in English.
Other information that needs to be provided: Social Security Number, your occupation, father & mother's name
and country of their birth.
Hours that marriage licenses are provided: Monday thru Friday 8:30am to 3:30pm
Wednesday evening - extended hours to 7:00pm
10/18/2006
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe}' of Marriage Record
:::::::::::::':::::::::::::::::::::::::::::::::::j:j:::::::,:::':::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::j::::::::::::::::::::::::::::.I:::8:::1:1111:1:::111'111::::11111:::1_1:::::::::::::::::::::::::::::::::::::::::::::j:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::j:j:::j:::::::::::::::::::::j:::::::::j::::
Search and D Fee $1 0.00 Search and o Fee $10.00
Certification Certified Copy
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
"::::::::::::::::j:::::::::::::::::::::::::::::::::::::::::::::'::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::1:.11:::11181&1::::1111:::111:::1111:::1&1::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::I::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
PLEASE PRINT OR TYPE
Name (First)
of
Groom :r (N.;
Groom's Age
or Date of
Birth
Residence
of
Groom ..)
Date of Marriage
or Period Covered
by Search
Place Where
Ucense Was
Issued
(State)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride W
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed \;)
(Middle)
(Last)
(First)
(Middle)
'D
~
(County)
\~
(State)
Olo
\'
'y CA\~
For what purpose is information required?
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.
Signature of Applic
/
Date
Address of Applic
\~'l ~i57~
~~-\'~\ ^:)( ,5 ('c-,. \\.5
\ \ 3
Please print na e and address where record is to be sent.
N~
DOH-301 (3/93)
(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 D Fee $1 0.00 Search and 0
Certification Certified Copy Fee $1 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of
Groom cY/1'f/
Groom's Age
or Date of
Birth
Residence ~ (County)
of
Groom c-$,S
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
R
(Last)
Of
(Middle)
~
(Last)
%
LIb
(State)
AJV
A#/d 9d
For what purpose is information required?
S~/4C- Su2<ACL~
What is your relationship to person whose record is requested?
If self, ~ "self."
UC::-2.!==
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date
u Y / d:JC;V
Pleas:JlTint name ~t address where record is to be sent.
/--/.0. ~y cX6;b
t{/#~/~EA ft4t:dJ IVY /qsto
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe}' of Marriage Record
...... ...... ............ ...........
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . .
.................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......~........................,...............
........ ........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . .. ................. - . . .
.............................
..........................................................
..........................................................
..........................................................
..........................................................
.............................
;:::::::;:;:;:;:::::;:;:;:::::::::;:::::::;:::::::::;:::::::::::::;:::;:;:;:;:::;
:j,'j"!::ii'::..II'::II:l:'B.lgIB:I:':III~IIQ,::i<I_1:1111)
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.
...................
.......................................
..-
r-7f' Fee $10.00
l.!:J 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.
........................
.......................
........................ .....
:Blie:\iis':':'::'e':':'::':E:n:U:Bi/:e:':':':'+e:':':';'::':libiiSg:':':::':":\;;l::tilrf:'B':':':'::e:':':'::.:.:.:,:.:.t:+.':'Fe':':';':e':':';':""
...... )rn~~k .;;~..::..:..:::r~~~~:4..:;:!~~t.:.;/rD*~....'...f"~~~i!L.;;:)::.;;:.......i~,~rLi:~:;.. :::..:::/
.. ...........
. . . . . . . . . . . . . . . . . . .
..................
............................................
.........................................
.......................................
. . . . . . . . . . . . . . ... . . . . . . . . . . . . . . . . . . . . . . .
...............................................
. . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . .
...............................................
..................................
...............................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..........................
........................
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits.
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
(Last)
I
UCCl
d 3\CoA
(County) (State)
u10nc t
u d-r- Cf2.
W
For what purITs information required? .
. VG\ bGL-h-t-p
In what capacity are you acting?
\J/
Address of Applicant
-;
\
W
DOH-301 (3/93)
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
(d&;
tttchA (~~)
What is your relationship to person wipe record is requested?
Ifself,state"self." ~ I t-
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.
(PLEASE SEE REVERSE SIDE)
VS-34M
-
N ,TE DEPARTMENT OF HEALTH
VEW YOP"ection
-2-taJ Re.
-.......
Application to Town/City Clerk
for Co of Marria e Record
;::::;;::;::;:;:;::;::;:;:;:;:::::;:::;::<::::::;;:;::;:;:. ..:.:-:.;.:.:-:.;.:.;.;.;.'.;.;.:.:-;';".;.:
...........;.:::::::;:::::::::;.>:::.;::.:..:::::.:-::::-:::::-:;:;....:::-;.;.:.:.;.:...:-:-:.;...;.:...:.:.
)mr.........v;.<'<p......'S\o.F<\a<<..'s... 88R":":0)0'<.. eBI'.~S..'.<..o<.((::.:c.......:.b..)W)a.':..""..""'.':l..')))
..... ..... . ..... .. . .... . .~v ...... CiCI m. . . .... . . eo",. .. .Ef.........
:::::)...:)...</<..:.:"":..;,..,.<{,,....:...:....:.:;:.....:.....:...:.)..:........)...:...:.......::....:..:.....<..,....:,:.:...:.,.)....:....:......:'<:,.<..,...:.........::.::...:...,.tt.........))))))
................................................................................................,........
..............................,...................
. . . . . . . . . . . ... .. .. . .......'.. ... .
...............................,............
...,....................................'......,...
.....: :.>. '.:.:.: /:::::::::::::::::::...:.:.:.:.:.:.:.:.:.., rr))\)))J)?Y\
::::}:)}{/H}'..... ,'.. .... ..,.... >... ...... '........ ... ..........
and 0
Se, t' Fee $10.00
~a Ion
Cf per copy
, Certification, an abstract from the marriage record issued
nder the seal of the Health Department, includes the names of
he 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.
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.
.. ...... .:.:....:<:::::::::;:;::::::::~::{{~~~~~\;~;~~~t(}f{:({)~;<~
.::.....<....."'.....}....::'.......:.E........:::........}.......:....'....'...........:::::S.......m........S........""p........O..........g..........M...::.....:.'..'.....::N....':..O..........':'.R........'S.....'M...."....'I..m..........");........E.........6........::::...
... .. ""1\;:'5' . ,.~,iI!'S . " .. ... . .... .. ... .,...... .. .......... ......
:,eJf!i~:::gRMmE...}'...L.:.)::\:....<i).::.L<':.."..:n
....... ... ...... .. ... .. ..
........................................,
.'.'......................,....................................................
:.;.:.:.:.:.:.;.:.:.;.:.:.:.:.....:...;<....:.:.;...
........................................................'........................'......................
..................... ...... ........
.' . .
....................................... ........ .........
PLEASE PRINT OR TYPE
Name (First)
of /' (
Groom ~ III
Groom's Age
or Date of
Birth
Residence
of
Groom ()
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
(Last)
!/V1
(State)
For what purpose is information required?
~C1 k>>e r:iL& 51
In what capacity are you acting?
:::::::;:;:;:::;:;::;:::
o
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)
(County)
tJrr
t (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.
dress of Applicant
{lo /JDX f3J
wj~7f ;1~ iL IV! ~ 12-~i 1 '3
DOH-301 (3/93)
Please rint ame and address where record is to be sent.
5~plk'" ttJ VE 1V/~LiO
(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 ~$10.00 Search and D Fee $1
Certification Certified Copy 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::I:II:II.:::lIIeI8I.::::@III::::III::::IIII:::III::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::'::::::::::~:::::::
PLEASE PRINT OR TYPE
Name (First) (Middle)
of C t _..-C-.
Groom ;,.o.C( ro -X)~ h
Groom's Age
~~ate of l \ \ q \ 1'1
Residence (County)
of D
Groom <.J +c.......
Date of Marriage
or Period Covered
by Search
Place Where
Ucense Was
Issued
~
(Last)
IfV'\I O~
(Last)
H-Q()cis
Name (First)
of
Bride ..(\Jl.8St:j
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)
(State)
(State)
.ss
N
c+ober \
WCXP
~ \-tall
For what purpose is information required?
Th Cj\C1~ {)C1~ .
What is your relationship to person whose record is req ested?
If self, state "self."
In what capacity are you acting?
If attorney: Name and relatio
whose marriage record is r
\017/o.e.
Please print name and address
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE) ,)' / ~ - ?f ~ <i) - ,-r.::?r 6
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
.
Application to Town/City Clerk
for COe)' of Marriage Record
Search and D Fee $1 Search and D
Certification 0.00 Certified Copy Fee $1 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (dFirst)
of ~ /
Groom '~
Groom's Age
or Date of
Birth '- I (~ q
Residence ~c:ounty)~Vil W':
of3/ (,'1 ,j Li S '-"~"
Gr~rtfV ~ J
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
(Last)
(State)
A~" \ ?"q ~h 19CJ 7
in V1 FClll'Sl NY
?
For what purpose is information required?
.c-- _1. fc:x- O\\~\ m \ (1'0.~ {~
CO'r<>t',,-f\c 0.. ~
In wnat capacity are YOll acting?
~'--~
Name
of
Bride \--\el\"SS.O
Bride's Age
or Date of
Birth
Residence I I.... (County) t!.
of ~I (,q N ~. ",,""-NV -,
BrideOt~ ~~\I~ \,\p
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was \N . c:-... l \~ l \\.\ 'i
Performed ~~\ ~ \ L-"-
(First)
(Middle)
(Last)
\N 'C"\' '0 '"
v.
04 - 2C\ -, (0,
(State) 'J. 'it; s,
'-~C~,
~<::::..
if attorney: Name and relaiionship of you
whose marriage record is requi
Signature,of plic8Jlt
..~.'
Address of Applicant
(MLG /
al<9C\ No"{~ \.J~, \-\~'-\ ,Lt
G~I\~;-n Ca.'\Q\\1'1G 2<=\.0,'3 l
DOH-301 (3/95)
Date
I
~~k ~O-.A..\ P-\
<: ~h (\0..., . 4
(PLEASE SEE REVERSE SIDE)
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j/-.L- ,~ ~~ /??.H"~c/
p
.
~ /-' "it"', tJ!:
'"
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'~
i
NY 126031
BR HT: 5-08 CLASS: E "",
ft. <. . ~
.'_ _ :. .,-1~ EXPIRE~ Qi"1j':,J
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ZC ~~ LUL D ~V JVt- L:--C€..v\. s....a.- ~ $.J 0 ,-d C) + <;~-k-
K.12.-Q l~~ ~O~ ~ ~(,olo(o ~ c;~Ga::. ~~~C)
-
'-- ---
\
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriage Record
Search and D Fee $10.00 Search and ~
Certification Certified Copy Fee $10.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
(State)
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
PLEASE PRINT OR TYPE
Name (First) (Middle)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
Ucense Was
Issued
(Last)
~-eV
YV ~
For what purpose is information required?
\ \{e \nSJ,l Vc{n(~
COYl\p ,
In what capacity are you acting?
If attorney: Name and relationship of your cr
whose marriage record is required.
~6
(PLEASE SEE REVERSE SIDE)
/MYYl ~ 9/~;0C'~
r lJU7l- ~ /JJ :/~~ 1\ 0 if U 1
c?o J3fl.. ~ \?-7 ~ D q t;
I. '7 ' -1 /. j 1-, ) (/ ~ J \ I <.j' oD '\ ~
f/L/~r~~ /['17/ /.?S70 f~vY~I~,fi\
. u,..jUn- /U ... I . f ~ ur; 1 ~
'JrU; ~.. )'Q / ~ ~
~ " /lLdA"u/ptW / F/e>/ll//1J I
#t~~, .. v-r/~ J/~~ r'
/t)~~/ . ~/7t-n(j~ ~/9Ir
. 1ry~~ I :. {~/ (/aK/)/;
O/~/JJ/?1U ~~~~~
p~' r
'{"""""",..,""'"
~ "Q'C'CT """"""",
~ rr.lCIAL SEAL" """~ ~'
~ BEVERLY J G i
~ NOTARY PUBlIc-STA RAHAM i
~ MY COMM~ADISON COU~~llUNOIS i
~mm nn~~!?,~,~~!~ES ~UNE 7, 2009 I
" u'uuu'u",,,,,~
,~~
~t?
~
NUMBER ISSUED
S620-5214-58~~,i:~
LOUISE A.~.." " ^ '.
900 TROfRJ::
E DWARf.,'
Jesse White - Secretary of State
EXPIRES
rBl:W
\
Birthdate .~~ ;'
Female 5!Q5, ,. ~;c JJIlL Eyes
Restrictions '.~.,e1ass
.H..... ~ D
cY?~O~
/
/
/
/
/
/
/
/
/
/
"
/'"
/
~ ):.
~~- O~!'o~
~ - ~ ~o ~, ..".~
~o~ ~~~a OA'~' c
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
~'-
Appliea'". ~r Search
of Marra....de Records
~
D Fee $10.00 l Search and
per copy , 1 Certified Copy
l
~
I: A Certified Transcript includes all of the items of information
1 occurring on the original record of the marriage.
l
~
I
~
l
Search and
Certification
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.
D
Fee $10.00
per copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veterans' benefits, court
proceedings, or settlement of an estate.
...,.......,.......
..................
...................
............ ......
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veterans' benefits.
PLEASE PRINT OR TYPE
Name (First)
Of
Groom
Groom's Age
Or Date Of
Birth
Residence
Of
Groom
Date Of Marriage
Or Period Covered
By Search
Place Where
License Was
Issued
>u~ ,ALb
III 30/'-I (
(Middle) (Last) l Maiden (First)
C vA,J;J 0 SIl2-A 'J~I ~~:ee Of ~ <.lb I -rf-\
f.
L
(County)
~ VI c 11 IS C;;:.>
(S~
MA'f' 20 (Cfe. 7
I
(Middle)
(Last)
f'\ A S I \5 IL;:' ~ r---.J
I: Bride's Age
1 Or Date Of
[ Birth
~:
1 Residence
~Of
i Br~-. ~v~ '- ti fi. ~-L
_....+-ff Bride Previously
l Married State Name :::I u') 1"'7 -4
~ Used At That Time
P:ace Where
Marriage Was
Performed
I Z. /;t / f (
(County)
(State)
c
fJ .,
11,- (A FFcfL '1
FI$H tLll L
.....................
.....................
.....................
......................
.....................
.:.:.:.:.:.:.:.;.;.:.:.;.:.:.;.:.:.:.:.:.:
::;:;:;:;:;:::::::;:;:::::::::::::;:;:::;:
.;.:.;.:-:.:.:.:.:.:.:.:.:.;.:.:.:.:-:.:.:
. . . . . . . . . . . . . . . . . . . . .
:';':':"';';';';':':-:".;.'.:
. ... . . . . . . . .
.....................
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
(t~:t~;/r~:~:~:~;(~:~:~;~:;;}~:~:~:~:~:r::;:::::
........................
...............................................
. . ',' , ,. ::~:~:~~~}::;;;;:;:::;;:::~::;::::::::::::;:::: ';:;'::::::::::;:i':-:::::::::-:.;.:.. .:.:.r:::::~;~::::::;::~:::;::;;:;;~:::::;::;:;: "::.. ..' .
.:-:':.:':':.:. ::::;:::::::::::;:;:::::::::::::::::::; ::;:;::;::::;:::;:::::;:;;;:::::;:::: :::::::.:.:::::::;::;.:;:::;:::::::::::::::.: ...............
..............................
..............................
:::::::;=;:::::::::;:::;=::::::::::::;::;::.;::-:.:.:.:::::.
. .. ...... .......
.......................
................'..............................
........................
.:.:.:.:.;.:.:.:.:.;.:.;.:.:.:.:.:.:.:.:.:.;.;,
....'..........................'..............
.... ..
... ... ..
..............".
...........,......
........... .....
For what purpose is information required?
50c I "'l '- 5cc L' IL il Y
In what capacity are you acting?
5f5Lr
1: What is your relationship to person whose record is requested?
! If self, state .self. C'F- L F
I ~.
,
~
1 If attorney: Name and relationship of your client to persons
I whose marriage record is required
~
~
i
~
...............................
........................'...;.:.:.:.;
:-:-:.:.:.:.:-:.:.:.:.;.:.:.:-:.:::.:::.::::::.:.::.::::::::"':':':::':::':':':-:':':::':"':':':';':':"':"':':.::.:;
~~1J!;\~'~~...
~
Address of Applicant
2bD 00 ..:-:bVM.~L 'r
fJ 6=0 f, v iLb -M l N - Y
::;:::::::::::::::::::::::::::::::::;;::::::;::::;::
. ........... J
~
!
1:
s(
I 2.. 5')~U
.:.:.:.:-:.:.:-:-:.:.:-:.;.:.:.:.:
:.;.:.:-......:.....:..........:.:.:.::::....
.....................................:................-:............
.................. ~....... ..
............................................'.........
................... ....
.....................
............,......
. .. - ~...
Date
'1/9/0--6
Please print name and address where record is to be sent.
e.. r-'.'-L. (~~) Z- '1 L - 32-b '7
DOH-301 (1/88)
(PLEASE SEE REVERSE SIDE)
VS-34M
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' 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.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
~ Fee $10.00
L:::l per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
.."",',",""..',,':,',',',..,,',.,',.,.,',',.,,.,',./,., '.'."'.'."'./"",,".""C. """6'.'.'."'<<'".'."'S..:....&.....:C.'....'g"....""g..""...'p..,.,.,'u'.,' "e'...'."$..'.'.'.e'.:'.:::p":"O:".:.S .':.'M..'...:.'4"...:'N...".."[)'.'.'..'.'."R.'.'.'"'&:'.'."IVI.::.:'I.*.'.'.'.p.......&....'.'&.'...'.""'."".'.""":"'.'.""'//.'//'/',.:..
'-.-'.....-.-,.,--.--....,.,...-.-...,'..............................................-:-:..,.> . .... c. ".' . .... ," ".' ..... ...."." ...c.. ," ," ..... . . '.' ',' ......,'.............._...,.,.........................._".
" " ",,,-,. ........,........................... .. ...,. ........ . . .. ". , .... .. ... ......",. .. ..... ,.. ,.. ..................................
.... ................... ,,' . '"' ,. .. ....... . .,".... ... '," ... ,"...... ... . ....... .",.. ...
.................. ',', .... ... ... ,.. ....... ...... .. .. ... . . ....".....",.......
........... .,...... . .... . ...... . ... ".'" ..... .. ........ .... ...".......",....
':-:':-:::-:::-:-:-:::-":-::"":::'-:.':-:-:';' ............. ....:-: .... ..... .:-:-.. '....::- ..:-:- .;.:-....;.: >:-.:.' .':-::- ','" :,'.:- .:-:-: :-:-: ... ....:.;.:.>;.:.:-:-:-:...'....
. "............... ','.' ..... '. . ....... ..........................'... '.".' ........- ........ ....... ..,.............. ',' ".' .... ...... ...,.....
. ... ,....- ..............,....................... .........,... ..- .......-..".,...,...............,.,... ...... .... .......................
. ... .. . .. ............ . ......................................, ,................................,....,...,......,.,...... . . , , . .. . .
PLEASE PRINT OR TYPE
Name (First)
~room Jo~ I
Groom's Age I
or Date of 0 5/7 ~
Birth
Residence (County)
of 1\
Groom I-.J u h".lu ')")
Date of Marriage }
or Period Covered ~ ( '3 6 (0
by Search
Place Where
License Was
Issued
(Middle)
M,cbl
(Last)
~~
~
(State)
NY
'{olAJ", C&2 <1<.
For what purpose is information required?
~r C)... C0f'i o~ IIUVlSL
In what capacity are you acting?
b(,&
fAP7~'_
Address Applicant I
"269 Po ru IQ... (.) 11/ d
Wa-fPlf\"S FCLIIs, /0 Y
12: 516
DOH-301 (3/93)
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 '/v( a. ,I ~ ~
Marriage Was II
Performed 0 V ~
(First)
S~Cy
-u/zo/'81
(Middle)
I~V\
(Last)
La..'SSI
(CoJ-lnty)
Dv ~vL. sS'
(State)
(V Y
What is your relationship to person whose record is requested?
If self, state "self." ~ ( f2.
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date
q t /e G
Please print name and address where record is to be sent.
'LO q po ~v I a... '6/ \J c!..
WG.ee\~(S F~(/5. NY l2S~O
(PLEASE SEE REVERSE SIDE)
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
JOSEPH RUGGIERO
TOWN CLERK'S OFFICE
20 MIDDlEBUSH ROAD
WAPPINGERS FAllS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCil
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOlONI
ROBERT l. VAlDATI
August 29, 2006
Scott Huggins
1109 Harbour Shore Drive
Knoxville, Tennessee 37934
Dear Mr. Huggins:
We received your request for a copy of your father's marriage license; unfortunately, we
have no record of his marriage in this office. Our records cover Town of Wappinger and
the Village ofWappingers Falls.
I checked with Town of Poughkeepsie and they have no record of his marriage in their
files.
Enclosed are the phone numbers of other town clerks in the area. Please check with the
other offices for the marriage record. Your father could have applied in any of these
other areas. Also, check the area in which the bride resided. Years back, a couple had to
apply at the Town Hall in the area where the bride lived.
Weare returning your application, check and notarization. Sorry that we could not help
you in this request.
Sincerely,
Sandra Kosakows
Deputy Town Clel
SCOTT L. OR TERESA HUGGINS
1109 HARBOUR SHORE DR.
KNOXVillE, TN 37922
5742
e-;) 5- ()~
87-4/640
Date
C/Vll{ ~ o+~
-iPAA cL,\\r.,^ ~ OO)~)
\r~
SUNTRUST"
Pay to the
order of
$ 00
I /Q
Dollars
fTI ~:~i~;::5
r 0..",,,"
.."
Fm '0"", ",,,,,,,, --.J~_~_-""
1:01;1..00001..1;1: 00:1S??BI..2~1I. Cj?L.?
Scott Huggins
1109 Harbour Shore Drive
Knoxville, Tennessee
37934
865-675-3593
Town of Wappinger
Town Clerk's Office
20 Middlebush Road
Wappingers Falls, N.Y.
12590
Ladies/Gentleman;
Thank you for sending me the enclosed application for copy of marriage record.
I am one of two sons to Mr. Thomas F. Huggins. My father recently passed away.
As you can see we have completed the application as completely as possible and
my signature has been notarized and we have secured the authenticity notary you
Require. Attached please find our check for 10.00 as well.
My wife and I are putting together a scrap book for our children regarding the life of
their grandfather. This document will assist us greatly.
Thank you in advance for forwarding a copy of the certified transcript.
Sincerely,
;;;gi7r
"'11 I. '''''''"1 .....~_I..,I.
.
NEW YORK STATE DEPARTMENT OF HEALTH
Vilal Records Section
O Fee $10.00
per copy
A Certification. an abstract from the marriage record issued
under the seal of the Health Department. inoludes the names of
the oontraoting 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.
I I UL
Fee $10.00
. per copy
A Certified ranseripl includes all of the items of information
occurring on the original record of the marriage
A Certified ranscripI may be needed where proof of
parentage a d certain other detailed information may be
required suet as: passporrs. veteran's benefits, court
proceedings, or settlement of an estate. .
PLEASE PAINT OR TYPE
Name (First)
of -n
Groom i l1orn4.S
Groom's Age
or Date of
Birth
Residence
01 ~ \ .
Groom U \,\.:+c'he.s
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
(Last)
r
IfI-S
..-J c.<.J) ,
(County)
/3
/929
. (State)'
~
l \
l0
~::~:::~jj~~~~g~i~~~~!~~~j~Ji~~r~~~~;'~~it~i~~~
Name
of
Bride
Bride's Age
or Dale of
Birth
Residenoe
01
Bride
. If Bride Prevl
Married. Stat
Used al That
Place Where
Marriage Was
. Performed
(Firs!) (Middle)
\<o.r€..n
( Last)
\-\ L--L \ () 5
(State)
N.
KO-f'Q.n C Cl..rv 0-.. \ \t D
[ STAlE OF lENNESSEE
COUNTY OF KNOX
~
I, WILLIAM MIKE PADGETT, Clerk of the County, within and for the County of State
aforesaid, t~ a Court of Record, do hereby certify that
-; r.#~5"# 1I,!::!{/A/5 whose name
is subscribed to the certificate of the proof or ac nowledgment of the annexed Instrument and
thereon written, was, at the time of taking such proof and acknowledgment, a Notary Public, in
and for said County, residing therein, duly commissioned and sworn, and authorized by the
laws of said State, to take the acknowledgment and proofs of deeds and conveyances, for
lands tenements or hereditaments in said State, to be recorded therein. And further, that I am
well ~cquainted with the handwriting of said Notary Public, and verily believe, that the signa-
ture to said certificate of proof or acknowledgment is genuine.
In Testi~ Whereof, I have hereunt
'J~
County, the _ day of
By
set my hand and af . xed the seal of the said
. '5 20 () ~
Clerk
Deputy Clerk
f Marria
......................+Uks>8e::<9.>..:S.:*0<s...:...:0.iD.::..e::s......I..g.s.......D>.t....G>h.....}....):~.k.........:Q.::.......:...:.........}......:::.:.:.......:.:.::.:..............................:.:......:........::............
. .........................:..I.....rr. . ...~... . ...~.. .... ... n..... . . :DC ... '.' nD .. . ................... .
::::::::::::;::::::~:::::::::::::::::::::::::::::::::::::::::::::>:;::::::::~::<::.::::>::;:::;:}::}::}:-:::-:-:.>:::::::::::.::::~::::::::::'::;::::;~::.:::::::::':.:.:::::.::::::::::::::::::;.;::<.::::::::~::>:.:::::.:::.:8!:::::::::::::::::::::::.::::):.:~,.::..:~~:~:::::::::;:;::;::;.;:.::::;.:.:.:.........
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.
A Certification may be used as proof that a marriage occurred.
Application
for Co
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.
........ ........"................,',..-.................,.. ...... .' .' ........... . .'. .., . .. .. ...... ... ........ . ..... . .......
..-.'.',.,.....---...., ..-.......-' . ........ .... "...",-. .... .... ................. .."....................................................,'"...,,,...........-...,..................,,...................",..,.,...............
.......................................................................................................p.....C.....C.....I\.......s....e.....o....O...............p...[......S.....*....I.........F....O......S...M.................N......O.........S...S.....NJ......J..m.......p....s....e................................
...... .... ,., ... ......""......--.'..............' ,. '"...........,.. .. .. . .. . .. .. .. . . .... .. ... .... .....................
......, "-.' ......,...............,..., ".......-.-.-. . ... ... .... ... ... . ... . ..... . .."..,.............
. ....,- ..,..-..........-.'........................................ .. ..... ... ........ . . . .. ... '. .... .. ... ......... .. ........... ...........................
, . .. . ..,.. ,. .. .. . . ........... .. .. . . .... . .. ... . . . . ... . . . . . . . . .. .. .. .. ... .. .. . . . . .
. .. ...,... - . . . . . . . . , , , ,. ..,............. . . ... . .. ... . . . . .. . . . . . .. . . .. . .. . . . . . . . . . . . . . . . . . .
. ,................................... . .... . ....... . .... .... ... .. '" ........ ... . .......".
.......,.......................... ... ..... .. ....... .. .. ... . .... .. .. .. . ...... . ,..... ..- ..........
... ............................... ... .. ........ ........ .. .. . .... ....... ........
. . . . . . . . . , . . . . . . . . . . . .. ... . . . . . . . ... . . ... . . . . .. . . . .. . .. . .. . .. ... . . . . . . . .
..... . ................. .. ... ...... ........ ...................... ........ ......... .......... ........... ....... ............ ........
.......",.."........."....,..............................................................................,-............,.....".,.............
... .................................................................................................."..... .,... . .
PLEASE PRINT OR TYPE
Name (First)
of /
Groom ~ll/
Groom's Age
or Date of E/ 7).
Birth ')..,
Residence
of
Groom ()
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
t/b1
(Last)
(State)
For what purpose is information required?
~&5f
t! t~1 ~Y-
In what capacity are you acting?
o
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
(County)
'}\;
\)
~ (State)
(Middle)
(Last)
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.
dress of Applicant
(lo /lux zj3 .
t Ur 71 ;JI-r! K- /vl L-( \ 2J.-i 1 -'3
DOH-301 (3/93)
Please rint ame and address where record is to be sent.
-:::Te:--;)Ik" AJ l) E IV! ~L to
(PLEASE SEE REVERSE SIDE)
'.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' of Marriage Record
<i:m~RIQf.#li~IIQlil'llp(~n~p~p"'.}<<
.................................................................................................... ........,.. ...................
Search and D Fee $1 Search and D Fee $1
Certification 0.00 Certified Copy 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurnng on the original record of the marnage,
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
...'.......................,,'......',......._..........................-.....,.,....................................,............"............................................,.....,...,...............:,...,.'.......:.:';...,......................,.,...................-:................................:....................:......................,..".............',....
':':':':'::>>>>:<':':':':'::'<>:<<":':<'::,':':':><':"::':':':':'>:<<<<'::'''<'::':::<::'>:':'P'''''u''::e'>>'j\:'>>':':S"":E":':e'>>"'oc,,:U>>':'>>'P">>'U"':cS'>>T""S' ""'F' "Q">>":.""'M':,>>c:'A':"':N>>':"O>>"':':"R>>"S'""M":"':I'm""::P' E' "1".'::'<'<<>:':':'::::'"':'>':'':':':':':':'''''
........'........,'..,.,..-.','...................-..,.,...,',..'.'.................'..,.........,.,.......................,...........,'.'............. ..... ..... '.. ....... ..' ..... ....: ... . ...... .... ,. . ...... .... . ......... '.. .... ,.. ... .............'.',.........,'.......'..................
.......,.,.,'.....'..,....'............,............',............................-..................,....._....'...................'.'....,......... . ..... '. .', ............ ..... . .... '.' '.' ..... .... ....... '.' '.', . . .... ...... . . .................................'.........
~~~~~;;:::::~~~:~~~~~~:~~~:~~:~~:~:~;:;:::::::~;;;:::::::::~:::~:::~~:~:;;;:;;:::;;;;::~:~~:::;:::~::::;:;~;~;~;~;~;~~~:~~~~~~~;;;;;;;::::~:~:;;::;;;:;::;:;;;.::;:;;:,~.~:;:;;:;:;:;:::~;::::::.~::::~~~~:::::;::::::;;;::;::.;:;::::~::::~:~:::;:;:;;:.:.;.;;:~:;::;;;.:,;.;;;~;;;.:;;:;;:;::;~:;::::~::::::.:::.:::.;;;;:;;;::;::;:::::.::...:::.::~:~::.;::'..:....:.::...:.:.:.:::.~:~...;:;:~::.::::::;.::.::::.::::;:;:~:~::::::::::::::::.:.:........
PLEASE PRINT OR TYPE
Name (First) (Middle)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Last)
(State)
\\
For what purpose is information required?
In what capacity are you acting?
/l-
Address of Applicant
/{)91 ;2'1- q
~
~#-;?
Il'(f
DOH-301 (3/93)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of 0-
Bride \vukJ.le
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(First)
6()~J2
(Middle)
(Last)
d-{S-Y~
(County)
(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,
Date
y
i>0
ame and address where record is to be sent.
(PLEASE SEE REVERSE SIDE)
Application to Town/City Clerk
for COe)' of Marriage Record
Search and
Certification
Search and
Certified Copy
NEW YORK STATE DEPARTMENT OF HEALTH
,; Vital Records Section
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.
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) (Last) Name
~ ~
Groom Bride
Groom's Age Bride's Age
or Date of 11_ or Date of
Birth j" Birth
Residence (County) (State) Residence (County)
of , 0 /)-7 of /\I11l {j /' ~()
Groom fV'\AA,'CO/A r,"- Bride J v I'"'jIv'vv?A
Date of Marriage If Bride Previously
or Period Covered \ _I (1- \ Married, State Name ./11
by Search 'b Used at That Time /v/ I
~:~s~: '10 ~ of UJAPP//llW ~':~7a:::S J.e/AP/J'ftrJ(JIr Yti ~lf /!/w
'F~~'~~t p~rpose' i~ inf~rmati~~ 'r~q~i~ed?' .. What is your relationship to person whose record is requested?
)~i'A ./ Ifself,state"self." (....1 ~
hod QA/q.,A1A)..... /1/(.~ A J<e))/f'lLv'1't,// '-Ju--J
J
(First)
(Middle)
.J
2-~ - 5
(State)
AZ-.
In what capacity are you acting?
setf
If attorney: Name and relationship of your client to persons
whose marriage record is required.
;1/~
Date
Ad pplicant
\~5 r w, A'c~ j)flJV~
SJ.)flY~:;eJ AZ ~'S3 7~
%-\ ~ ~00
P~~; n,i;j1dreSS where record is to be sent.
\ ~3S? W, ~'c.CAA;e })A/V~
Sj)J..JJt~ Ii Z ~ S
DOH-301 (3/93)
~ No.. """" SOle "......
Maricopa County
Cheryl Lynn De Cuir
My Commission Expires
04/02/2010
/? '
{~~ /L ~
(PLEASE SEE REVERSE SIDE)
AUG , 8 2006
TOWN CLERK
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
JOSEPH RUGGIERO
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
ROBERT L. VALDATI
August i\ 2006
Mingo & Justine Henley
12359 W. Pic erne Drive
Surprise, AZ 85374
Dear Mr. & Mrs. Henley:
My office is in receipt of your request for a copy of Marriage License. In
accordance with regulations set forth by New York State, there are certain requirements
to be met before my office can issue a certified copy or transcript via mail.
Please fill out the enclosed form: DOH-30l - "Application to Town! City Clerk
for Copy of Marriage License".
Please have your signature notarized and obtain an "Authenticity of Notary" from
your County Clerk's Office.
Please include a photocopy of your Driver's License.
Finally, please resend your money order for Ten Dollars. The money order
originally sent is being returned to you.
Feel free to call my office if you have any further questions.
Sincerely,
itcs~
Town Clerk
Town of Wappinger
10: 500 132 235
~
NUY,JUsTfNE,A
VANDElllituRGH ..
121.
02..()4..~
set F EYEs: __ HT: 4-11
E NONE
R: NONE
ISSUED: 03-21..Q6 fXPIRfS 02-04-11
75MOno
/""
RECE\VEO
AUt) , 8 2006
TOWN CLERK
To Whom it may concern,
I~ We need a copy of our marriage license. We were married in Wappinger
Falls, on Jan. f 1997. Here is the list of info you need from us.
Justine Henley and Mingo Henley
maiden name Justine Jallade DOB 2-4-1975 mothers maiden name was Schultz
Mingo Henley DOB 7-6-1971 mothers maiden name was Burgos
Please mail the copy to:
Mr. And Mrs Henley
12359 w. Picerne Dr
Surprise Az 85374
RECEIVED
AUG 1 8 2006
TOWN CLERK
Any questions please call: 1-480-467-8865
THANK YOU
~r~
Mingo Paul ey
-~~~
Justine Ann Henley --
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' of Marriage Record
:[:[:::!:[:::::i~:~:::j[::[[::::::::::::::~:~i::::~:::::::::!~:~:::i~~:::::::::[:~[~~::~:::~::::::::::!::[::::::I:::[:::::::::[:::[:::::::::[:[:~II.II:::.:::IIIIII;:::1111111::::11111.:::.,,::::::::::::[:[:[[:::::[::::::::::::::::::::[::::::::i:::::::::::::[::::::::::::::::~:~::i:[:::[:[:[::[:[::::::::::::l:::i:::[:[::[::[::::::::~i~:::::::::::
Search and D Fee $1 0.00 Search and D Fee $1
Certification Certified Copy 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
~::::::::::::::::::::::::::::::::::::::::::::::::::::::~:~:~:::::::::::::::::::::::::j:::::::::::~::::~::~~:::::::::::::::[::::::::::::::::::::::::I_I::~_Bg_.::~1111:::~.I::::I:III:::lle:::::::::::::::::::::::::~:::::::::::::::~::::::~:::::::::::::::::::::::::::::::::::::::::::;::::::::::::::::~::::::::::::::::::::::::::ii:::::!!ii:
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (First) (Middle) (Last)
of of FEELEY
Groom DONALD W . JOHNSON Bride CRYSTEL
Groom's Age Bride's Age
or Date of or Date of
Birth 9 / 20 / 1 95 6 Birth 9 / 1 3 / 1 9 5 6
Residence (County) (State) Residence (County) (State)
of of
Groom DUTCHES S NY Bride DUTCHES S NY
Date of Marriage If Bride Previously
or Period Covered Married, State Name
by Search July 3 1 , 1 9 7 6 Used at That Time
Place Where Place Where
License Was Marriage Was
Issued Wann . Fall s. NY Performed
For what purpose is information required? What is your relationship to person whose record is requested?
cO 57 O~G'TlUfT L 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.
S elf
1~~liC/J?4J ( )S) Date ~//~/o
. 0 (0
" W'V"_ · ~....,.
Address of Applicant , Please print name and address where record is to be sent.
1:1- BELt IT1=',( L fr"u E
W A ~ f fA- t.. L <; ~ ()
) )...~1
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
kj)~/~
-tL
:------
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for eoI!)' of Marriage Record
............................. i.'iii:i:i"i'.IIII!i:lfi'il:I;II:I:!:III~III:i:illflqi''Io.l:!:!:'" .................... ..................
........................................................','
..........;..-:.........................................',"
..... ", ......................
...... ...................... .. :::;:::::;:::::::;:;:;:;:::;:;:;:::;:;:::;:;:;:;:::::;:;:::::;::::::.:.:......
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
............................................. ....................................................
..............................................
.............................................
....................................... ...... :;;;;::;:::::::::::::::::.:.:-;........
. . . . . . . . . . . . . .............................
Search and D $1 Search and 0
Certification Fee 0.00 Certified Copy Fee $1 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marnage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marnage occurred. proceedings, or settlement of an estate.
O":ii,i::ii;;::::::::: "ii"i..I:__I.::IIIIIIMli:i:lllli.:III:li.I:llli"mll.'
...........................................
.............................................
............... ............................
.............. .............................
...........................................
..............,.............................
.............. ............................
.............. .........................
.:::::::~:~:~:f~:~:i:~:~:~:~:~:~:~:~:~:::::::::::::::i:~:::::~:~:~:i:i:~:~:~:::~:::~:~:~;::::::::::;;;;;':':'
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits.
PLEASE PRINT OR TYPE
Name (First)
~room \J I I \i Ct
Groom's Age
~~r~ate of , I - II - I q Lf k
Residence (County)
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was \ I, \\ /'l
Issued V \ \u.
(Middle)
(Last)
lut
rvv:xe
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 C It
Performed 0'
(First)
Ka; e fY\Q r
(Middle)
(Last)
'R ife(\ VIl h
<6- 5-'- /9 '15/
(State)
N
(County)
1)u\ch~ss
(State)
)./V
o - l d-- - lob
Qrt LUQ
For what purpose is information required?
.(;~rz ~U::icJ Secor; ~ bl~c;h/, &
What is your relationship to person whose record is requested?
If self, state "self." C) --f if
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
/'/'"
Signature of Applicant
Date
~-
~
~/fR.d1 VI {J,(
).J L( (eJ. S d) j -
6. Jf ~
Please print ame and address where record is to be sent.
Address of Applicant
7 y Dee,A4vt5.4/
DOH-301 (3/93)
VS-34M
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' of Marriage Record
>rnlel~:ERlggBI:I@iJBI!(I~.19~lm.i~}q
Search and D Fee $1 Search and ~
Certification 0.00 Certified Copy Fee $1 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original.record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
..... .. .... ...-.......... ...... .., '." ....... ... ." ...... ....... ... ". ,...... ... .... ..... "' ",. ... ... . ..... ", . .. ......",. ..... . ..... ... "" ...... ,. ,.......
.........................."................."..........................................................................,................................................. ...............................-..............................
..........................................................................p..C.....S....A.......S.q.e....c.....O........U........p.....U.....s....m....s.........p....O.......S...M.....q...........N....S..q...a.q..S....Mq...J..71....""1... e.. e............."....................."
........."......,...................................""",...........". .. ... . .. . .. .. ..... .... ..... .... ............................
>))..............;..!....><;.::.>>.
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
l(~ '\"
l'1tt\
(Last)
~ {)1 (C
(Last)
CA1<t-L'ltv -J 6lJ1~
1/'1/rrtt<8'
(State)
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
(First)
(Middle)
(County)
(State)
k\-eS5 N
1/ /2 ! J qq C:,
6~
(110
..--
() Ubft-1C.ziY5 JL
It
What is your relationship to p~on whose record is requested?
If self, state "self." ~e l T
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Address of Applicant _
t.8 pOlIV ( ~1
{\)EkJ H4-~ N'i 1t-~tJ
Please print name and address where record is to be sent.
DOH-301 (3/93)
(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 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
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.
....:::::::::::::::>:>:::::::>::::::::::\\::::::::p.:::u:.\::15:.:....I\::.<::8::....:e::.:.>.::..0::.:.::0>....:::I\1..::::.:.p.:.:....U..::::::S......:l":.:..:.S...::>.p...::O>:':::JI::':':'::M"::"<::A>:::'N:':"::a':':>:/e":":::'S.:....::.::::../.:::.....:.:...:.......:..::.::;:\::::::::\::.::.:::::>::::::::::::::::::::.>>.:.>.>::::::.>::::::::::::::::>:.>:\:.:/>::.::;:.::>:::::::
...... ..... ............ ....... ... . . . . ..... . .... .. ... ........ "M'lm...a..e..e.. .......................... .............................. ...... .....
.............;..,:-:-.................. '.. :-", ..... ............ . .... ',' '," ..... .... ....,... ',' .... . . .... ...... . . .......................'............................................................................"........... .....
...... '" ......... . .... . ".".... . . ... ". '" '"' '" ." ." .. .. .. .", .. .............................. ...-..... ........... ,. .
.. ........,;....<<::-:-:-::> ............ ....:-: ,",. ...... <:>.. ";':> .':-:- -:-:":' :-:. :':-. :. . ,':-::.... :.;. <<< :-:-: 0" ....:-:-:-:-:-:-:-:-:-:-:-:-:-:-:.:-:-:-:-:.:-:-:-:-:-:-:-:-:-:.:.:.:-:.:.:-:.:.:.:.:-:-:-:-.-:.......
..... -... ...... ...., .......... ..... .... . ... ... .... ...,........................ .......'.'... ..... ....... .... .....................................
.................-.......,....... ...................,........... ....................................... ............................-.............................. ,.
. .. ....................................... ........................., ,................ ......,.,. .....,...........,................................. .....
. ............. .......,....................................................................................... .
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom '1)w ch
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
ex+-
-z
)1&D
Name
of
ride
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)
Lon
(County)
(State)
(State)
For what purpose is information required?
fr5H 8 f't V/.t1j }" 0D n4
What is your relationship to person whose record is requested?
If self, statsz.f-"j r-
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
,
Add') ~ AP~C~~rv rl'1 (ld Q/c:
Please print name and address where record is to be sent.
w
Jon / ~
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
... U; I:
'-' . ....1- -... '-', ; .....
I
APPli*tion to Town/City Clerk
for 0 of Marric!,ge Record
I ~:~~~a~~~ rYj f'<:~ $1 a',ne ~:~~:d~~-! [J"'" Fee $10.00 i
~! ~ \?r copy I-'/l per copy
A Certification. iO:n :=tbelraci 'IUi"(; (,if;! Triai .-;~ge ; o:::ccrd '%ued A Certi~ad Tj :::ns/)riptlncludes all 01 tha itl~m$ of IT'lfOrmallon
under the seal o11he Health Departmer:r, includes tne name::s ui I vcc:':~:i:i~ '::!"! t"'''' "lrIglnal record ot tile marnage.
the contrac:ing tJartie:l, tl'0ir ~esldenceallhe lme: !"<,icqnse
was issued as well 35 dElta i::r'd ol!Ce o't birtr: of the bride and i A C,",,1ifio.:l T anaCi ipl rr.;~V b. needed whl~re proof of
groom, I pill..::ntage an (:erU~if1 other detailed information may be
required such ~' passports, velera:"s berefi\$. court
pr<'leeedings. ' r s51ttJemenr oi an \:latale.
\JEW '(ORK STA-:-r: D~po.RTMEi'!T OF HEALTH
Vital Records Section
A Certific<ltlon ml:lY b!: u~ed as proof :tlal a ""am:<g;;' -?ccI,JrTred.
i:;\;~'(:'
jName
Of
Bride
fJ'1t:le's Age
or Da!e of
~1r.th___._
(Middle)
~!)
c{
is and relalionship of yoyr client to persons
record is required.
DOH-[30, (::)l93\
RECEIVED
AUG 0 9 2006
TOWN CLERK
.. j.;' .
-
-- MASSACHUSETTS 0
NUMBER
530559230
DATE OF BIRTH CLASS REST
09-26.1936 0
EXPIRES
09-26-2008
TORONTO
CAROL A
99 BAKER AV
BEVERLY,MA
01915-3539 (!aaf a
DRIVER'S LICENSE
.
.
HEIGHT SEX ~.
5-04 F -
09-26.1936
~i
~.,.,
:p
5'
August 3, 2006
Town of Wappinger Falls
Town Clerk
20 Middlebush Road
Wappinger Falls, NY 12590
Attn: Sandra Kosakowski
Dear Ms. Kosakowski:
I wish to get a copy of my parents, Mr. & Mrs. Patrick Ryan, marriage certificate. Both
are are both deceased. Per my original letter of July 21st., $10.00 has already been sent to
you. Per our phone conversation, I am now submitting my request which has been
notarized.
The purpose for the copy of their marriage certificate is to obtain an Irish Passport. My
father was born in County Limerick, Ireland, and this copy is needed by the Irish
Consulate of Boston.
I appreciate the consideration and time you have taken to help me.
Th..ank.m:YOj; /J ~A7~" - ~
et~ Lt.( ~()
Carol A. Ryan Toront
99 Baker A venue
Beverly, MA 01915
978-927-7480
Personally appeared before me this 3rd day of August, 2006.
~@k2J~
M. E~~ahill,
Notary Public
(f)
. ELlZAIETH CAHLL
NOTARY PUIUC
~IIWIAL,," Of IlAIlACHUIETTS
MY COMMISSION EXPIRES
JULY 2 "'010
(f)
. ......". CAHU
NOTARY "*JC
~1.r.lUU""~
MY COMMISSION EXPIRES
JULY 2, 2010
~
7- 51-t'/; ~ fif dl;~ Urltt;~ #l
1?A11t~ utl/v tf- &:It ~ Vt1;ttfltt~ l~&II~
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1{. 3 t' .6
1, ' f;Jflf,'oK XYlfN
CRaIl}. jJflj(~/'eflN
fj{,'1J{: /J /'JNC
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' of Marriage Record
><I'Illgffi:II~IIIIII~ftlg~gl~p~~n~l<><
Search and D Fee $1 0.00 Search and D
Certification Certified Copy Fee $1 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marnage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
...,.........:......,..............;-:.',.,.',.,.......-..-...',...............,:-:.............-:.......:..........;......................................;...............................:...".....,.........-7..............:...........................-:................,........,...................'......,.......
.....................................'..p.. ...c.....e............S....S.......C.....O........M. ......p.....U....S.....]1....S.........I;... O.......R..... ......................0........8.....S...... ...m;....F....S....S.......
. . . , . . . . . . . , . . . . . . . - , . . , . . . . . . . . . , . . . . . . .. ....,,'. . . . . - . . . .. . . . . . .. . . . . . .. . . . .. . . . ... . . , .
.....................,......................,......,'....-,." . ... ... ...... ... ... . ... .. .. . .. . .,.
......_..............'..........,.........~........ .."..... .. .... ......... . . . .. ... . .... .. ... ......... .. .. ... ... ... ......
..............."........,..,.......,..".........,.,......... .. .. ...... . ... .... ..... ... ...... ..... ...
.'...'.'..'.....'..'......-...".....,.."...........,,""" .. .. ... ... .. ........ ...... .. .. ... . ....
:::::::::::::::::::::::::::~~~:~::::::::::::::::::::~::::;:;:;::::::;;;::;::;;::::::::::::;:::~:::::::::::::::::::::::::;::::::::.::::::;:;.;.;:;;:::;:.::::::::::::;:;::::::;;;;::::::::;:::::::.:::;;.;~:.:;:::::.::;:;;;.:;;.;;;;:.:~:::.:.;;;;;;;::.:::::::;::;;:::::::::;:::':::':::':;;::::::::':::::::'::":::;'::::::;';;;".:....:.:;.:.:.:.:.::..;::..':::::::..:;:;:;..:.:.::.:.:.:::::::
."........... ....... ........... ...... ...,.. .... ...".......,
.......... ..........,.... ...........,......,............. ...
...................... ......... ...... ..,..........., ,....',......,..
..... ................ . ,......,............ ,.,...,..... -..
...,................,.,....... .....,....,......., ".....,.......
.... -.',....,....,......_,. .....,.".......,'...............
.......... ....,. ........,.....,............., .....",.
....,....'.'.'...'.......".-.."......................
..... ................'........,....-.................
....,.......... ..............,..................-...
.....'.................................................'.'.'.......'............................,
............................ ............ ....
PLEASE PRINT OR TYPE
Name (First)
of c' "..
Groom J/) /~ c;-:: S
Groom's Age
or Date of
Birth
Residence
of
Groom
Dale of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Last)
~~F,?7NCCJ
Ij-;2L(- 3 I
(Middle)
::r
(!,
If-I/
(County)
(State)
Name
of
Brid
Bride s ge
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where .:-,.- ~ /'
MarriagewasSl MR)~ ul/t-JRcd
Performed I U / /
(First)
(Middle)
(Last)
"
3/
(County)
(State)
For what purpose is information required?
W Ir G- / j) C4"c( D
What is your relationship to person whose record is requested?
If self, state ~'
In what capacity are you acting?
Ji<< b B d- /J/ ,L)
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.
S'#/I( G...
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
, .
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe)' of Marriage Record
. . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . .
....H........................ .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..............................
............................
. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . .
......................
......................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .. ..........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
...................... .......................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................................
............................
........................... ........................
.......................... ...................
........................... .................
..........................
...........................
..
......................................
...................................
.... . ........... .............
........ ... ... .. ................... .............. .
.... ...... .. .... ... ......... ......
~q.E..::~)!!l:E..::~~d:.::::~E':::S....:I..:8E..::~4~~~Ak.'::):~:n::~\
:::~:::::~:~~r~~~!~~~f?:.:.~.;.::::Mg:~:~g::.:.;.;:M"!lP~:~:M::.;.;.;::::.:::::.:g:.:.;.:,K::;:'R[~BM:.:::/:":/.;:Yl::
...................... .........
.......................,.......,
............................
. . . . . . . . . . . . . . . . . . . . .. ..
....................
.. ........................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . .
......................................
......................................
d....................................
.d...................................
......................................
...................................
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.
..................
..................
..................
.................
.................
.................
.................
.................
.... .................
ilbl.I:!!IIIIIIII',EIII::::III:.::I:II~I.:!III!::::
......................................
.....................................
......................................
.....................................
......................................
.....................................
......................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
............................... .
.......................... .
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits.
PLEASE PRINT OR TYPE
Name (First)
of
Groom '\
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
.................... .................
....................
.................... .................
. . . . . . . . . . . . . . . . . , . .
.................... .................
. . . . . . . . . . . . . . . . . . .
...................
...................
.................
(Middle) (Last)
WA
(State)
~(\~-
In what capacity are you acting?
DOH-301 (3/93)
........d..........
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
....................
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
....................
. . . . . . . . . . . . . . . . . . .
....................
. . . . . . . . . . . . . . . . . . .
......................................
.................................. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .........................
Name (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)
What is your relationship to person whose record is requested?
If self, state "self."
3et\
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.
(PLEASE SEE REVERSE SIDE)
VS-34M
~4
V ,~""'-/'~"'/
(V __,,," ~
(0 (crr JOG
fA 'J/o3c6Xx
In order to determine your eligibility for assistance, we need either the information
listed below or you to take the action listed below:
'SP
~ ec- ~~~r
tr~\A~ ~~l.. \dOll ~W~ f 6'tf.~.
If ~,ffII u~~"{~l2yVrtl\'\- Pf~''b CJvd rc,
t , yw ~" fro J:t~ €" MP. ~,i-, WhoW
'0\W1 lkych, ~ V1 dIU-' '6Mt f!Jwc)"
M~. --'
If you do n you have done what we have asked or gl the
~ ' anon by: 7 " , 'f1.e will have t<( take action in your case. ,
~ ~'()'( ~,~,QT ~ uruc.n' 510$'- frwrff
~~-~~x_~'dre ~Jr::;' '1ltf, 3~~~ (!J~xj
~ ~f) fJ! VYl eJ.' l' SOCIal Welfare Worker
SSPA.45 b'1 lqn kiCl . -c1'"
Rev. 8 /98 J" .
~ :J y '~f11 JIll ~l i r-J C~ -1 b( YYlL1 '
-...
Page 1 of 1
Sandy Kosakowski
From: Chris Masterson
Sent: Tuesday, July 18,20068:56 AM
To: Sandy Kosakowski
Subject: FW: marriage license
Chris Masterson, Town Clerk
Town of Wappinger
20 Middlebush Road
Wappingers Falls, NY 12590
845-297 -5771 Office
845-298-1478 Fax
-----Original Message-----
From: Jennifer Westermann [mailto:skyejenn@stny.rr.com]
Sent: Monday, July 17, 2006 10:37 PM
To: cmasterson@townofwappinger.us
Subject: marriage license
To the Village Clerk:
Is there a way I can obtain a copy of a marriage license without being there in person? It seems as though we
are only in the area during non-business hours.
The marriage was that of John H. Westermann, Jr. and Jennifer G. Strong on August 27,1978, Zion Episcopal
Church, Wappingers Falls.
Thank you for any help you can give me.
Jennifer S. Westermann
~/~ 1/17 ~ _
dJ ~ ~ A /,.u:to ,.//~ ~ t
~~..
7/20/2006
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 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.
>>RCiISEBOliet.ETEFlli:IIQREMtmIEsi<>
..-.,.,........,..........'.....'.......'.'.'.'.....................................................'.........................................................:...........,....................-.'.....................'....,..............-.........,.............,........................... .
............................................ ...... ...................................................
PLEASE PRINT OR TYPE
Name (First) (Middle)
~room tArl 'J.I<:.o h d I J;c. e(
Groom's Age
or Date of
Birth
Residence (County)
~room D ~.l,J" e ';5
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
34
(State)
"JJV
9 'u~c
Ie; '7 :;-
For what purpose is information required?
~ C S 5 foe--\-
In what capacity are you acting?
(First)
(Middle)
Name
of
Bride I d~S-('~
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
A V\ ,,,-
Zy
(County)
I) Vvl vi e ~ s'
(State)
v,IJ 'r
~A
What is your relationship to person whose record is requested?
If self, state "self." 5/.2....-1('
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applicant
~.?17
Address of Applicant
776 Oelj,~~
W "'-ffl /Lp~S
I-! , I (
/"
;- "'i. 1/5
Rd
J-J'-(
(L..-sc'u
DOH-301 (3/93)
Date
/r J IA I
Ob
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 Clerk
for COe}' of Marriage Record
................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .. ............... .... ...
........... .. ...............................
...............................................................................................................................
...................................................................................................................
.................................................... .
:..i.ill:.II::.:g'I::I:IIII.g'III~III..:.~llill::.llil,I:I:I:!!,::!!.!::
.................. ..... . ....................
.........................................................
.........................................................
.........................................................
.........................................................
.........................................................
.........................................................
.........................................................
.........................................................
........................................................
......................................................
... ............ ..... .... .....................
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.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................................... .........................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................................... ...................
...................................
...P............................
...........................
. . . . . . . . . . . . . . . . . . . . . . . . .
.................. ...
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.
........................................
.....................................
...................................
..............................................................
............. .............
:::::ii_~.:I:IR~glll:'_A':I.~.i::~.I~I.I~~,I.<.::::::'::...
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last)
of -r-:::
Groom -..J
Groom's Age
or Date of
Birth
Residence
of
Groom N.
Date of Marriage
or Period Covered :JV.....e... '2- i5, {j7Jo 3
by Search
Place Where "\"0-....:> \.-:' 0
License Was WG.\? 'P i V\G e. <'
Issued .J I
...........................................................
.................................................
.................................................
.................................................
.................................................
.........................................P..... ...
................................................. ...
Name (First)
of -r-
Bride ..j o.c.
Bride's Age
or Date of
Birth
Residence
of \ " \ '
Bride \J"-'C\..OfJ..hl
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle) (Last)
0...(,'\11"'1\1
For what purpose is information required?
105+
In what capacity are you acting?
Address of plicant
131 CIder yYI ,'11 kbl::>
VVqPP;V13~'.s ~\k, N'r12 ij9a
DOH-301 (3/93)
.\1 ~e epS-I' e f /\1 Y
What is your relationship to person whose record is requested?
If self, state "self." ~ e \+
If attorney: Name and relationship of your client to persons,
whose marriage record is required. /.,
/
/
/
I
. ; VS-34M
'"
\ \
\-
'~_.....
(PLEASE SEE REVERSE SIDE)
f',E.CE.'\IE.O
l\)k - Ii 'l.~
10\HN C\..E.f\K
~~ ..sMUi fMl O{$-, u &f
C5f1J L( cJ I f--U-( ('vt a rY7 ~
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Cetliticafe
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", 7.jeat.......~.~.~.~......
)his cJs 7-" Cedi',!
that................ .J.~I!!~.~. .~~~~;:~. .!g~~~ 1 ~ Yo"...~!:.~ .'........ ..... te~iJiH'I at. ...~.~.~~~.~.!.. ~.~.~.~.~~~.~.~.~.~.~.........................
wI." waJ tCV&H . ~X...?~.1.. }.~~.~... ..........0.... ..................... .at............. ...... ~.~.~~ ...~.~~.~.~.~.~.. ~.~~..~.~.~.~................ .......
a Hi.......... 00' o. ~.~.~.~.~.. .'!-'.:...~ ~~.~. ~................................. .....te~iJiH'I at.... ~.~~.~...~.~. .Y!.~.t?t?~.~.~.~.~.! ...~.~.~...! ~~~..... ... ....
IV!." lVa" bot H .~?.Y... ~.~. ,.. J. 9.??.. ..................................... .at. no.... ........... ~.~!! ~!!~ .~.~ ~.r:.~.. ~ .~.~.~.~~ ~.~.~.~.~.?................
wete ~~ttieJ .oH.~~~~.~i~.;1;r.~.;........_.~~.~.~~..~..':~.~.~.~..:;:~~~#~~~~~~~:~~~;=!~~.~..~....
as ShOWH tv tlte Jul,! te,/utetuL liceH.~e aH.i cetlilicale 01 matti4'Je 01 sail ,etsoH.~ 011. lile in t!..i~ ollice.
[ ~eaL]
..&:l..tL.Cf2:. ~.
Deputy TOlVN~CLE~
:bate" at .........\i~.p.p.!-:~g~;:~..f.~!!~............ AI. y.
0...................... .......... .~~~~.. ~~.~.. .~.~~.~. .... ............ ...........
Any Alteretlon Invaliclate. Thl. CArtlftcate
Issued Pursuant to Section 14-a, Domestic Relations Law
~~c~\,,~o
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VS.IZ (Rev. 1171)
1\
,7
TOWN OF WINCHESTER
OFFICE OF THE TOWN CLERK
CERTIFICA TE OF BIRTH
FROM THE RECORDS OF BIRTHS IN THE TOWN OF WINCHESTER, MASSACHUSETTS, U.S.A.
Date of Birth
Full Name of Child
. . . . . M;;~y. .1~. ~ . .1 ?5~. . . . . . . . . . . . . . . . . . . . . . . .
Elena Therese Breen
Sex
Female
White
Place of Birth
. .... ~.~n.c:J:1~~:t:~:r:.. ~.o~r~ :t:~~.~. ~~~<?~~~.~~.x: ~. .~~~:=>.......
101 Bromfield Road, Somerville, Mass.
0......................... ... ..................................
William Clifford Breen
Residence of Parents
Name of Father
Occupation of Father
Birthplace of Father
Maiden Name of Mother
Birthplace of Mother
Date Recorded
Leather Worker
. . . . . ~~~.c::~.~s:t:~:r: ~ . .M~ss"
Recurd No./Book/Pagc
. . . . . ~~a.~~.e~.1:;~. .<;~.9~.~n.Cl;. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . M~Sl.wa'y !. .~l~~~.". . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . M~Y . 2.~,. . ~.9. ?? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . .#. . 4,71, . .B~.". . .1.1!. . p.. 2.~ . . . . . . . . . . . . . . . . . . . . . .
L Carolyn Ward, depose and say that I hold the office of Town Clerk of the Town of Winchester, County of Mid-
dlesex, and Commonwealth of Massachusetts; that the records of Births, Marriages and Deaths in said Town are
in my custody, and that the above is'a true extract from the Records of Births in said Town, as certified by me.
WITNESS my hand and the Seal of said Town, on the a. . . . ~~~.g1:1. .1:1. . . . ';ij' .. . .
clay of .......... ...Mar.ch..... 1983. L
I.
..... ................. ...... ..........
Town Clerk
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for Coe,y of Marriage Record
..................
..................
..................
..................
..................
..................
..................
..................
. . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
....................... ...... ........... ...........
..i:i='.!:.:!:i.II!::.R~..il.IIII:lilll"llltlmill.:lgi),~:
. . . . . . . . . . . . . . . . . . . . . . .
.......................
.......................
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................................
....... ..........................
.................................................
........... .....................................
.......,........................................
.................................................
........... ....................................
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.
......................
......................
......................
......................
......................
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. ... .............
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
........................................................................................................................................... ..................................
........................................................................................................................................... .............................
:::::::::::::n:if:::~::A::e:i!'::::m:~b.:::::E..::ME..::.::::eAR.::..M..::".::::=:jifN...:."::::n:E..:::M..::.~:::i!'i!'E.::::: ............ ..::.:.:.:.:.:.:.:.:.:.::.:.:.:.:.:.:.:.:.::::::..............
::::::::::::~~:~P~~E:~:!Pr9PJ.r::::. '}fj ...:.:~:::tI8:::~:::.;. . . {~M. :: ..:at!!~ '::.., ..J.:~rt2S:..:.:.tt:~:r:::::::::::::':':':':'" ::::..... ............................. ......... ............................... ....
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits.
PLEASE PRINT OR TYPE
Name (First) (Middle)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search tv)
Place Where
License Was
Issued
. . . . . . . . . . . . . . . . . . . . . . . . . .
.........................
. . . . . . . . . . . . . . . . . . . . . . . . . .
.........................
. . . . . . . . . . . . . . . . . . . . . . . . . .
.........................
(State)
In what capacity are you acting?
Address of Applica
\~~ 7 ~-\ 37~
t0off\n<)~"5 ~I
DOH-301 (3/93)
Name (First)
of .
Bride C\tu.c
Bride's Age
or Date of
Birth
Residence
of
Bride \.A:.
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle)
(Last)
(State)
N
If attorney: Name and relationship of yo
whose marriage record is required.
(PLEASE SEE REVERSE SIDE)
VS-34M
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Search and ~
Certification Fee $10.00
per copy
A Certfrlc:ation, all iibatract from the millTiage record issuet1
under the seal of the Health Dep.nment, includes the names of
the contracting.parties, their re$idence at the time thelieensi .
was ieaued as ,well as dale and place of birth of tha bride and
, groom,
. A Certilic:ation may be used as proof /hat a marriage occurred.
PLEASE I=RINT OR TYPE
Name (First)
of
Groom ~\'fr'Y')nd
Groom's Age .
or Dete of
Birth
Fl~idenc8
of
Groom
Date of Marriage
or Period Cov.rlid
b Search
Place Wh....e
Ucertl,ie Was
ISSued
(Middle)
( Lilst)
~o..()~ 1:-~ \
1 \- d. -:0-(0
(County)
(Slate)
"->,
~he~S
0"7-
For what purpose ii, informatiOn required?
'f>~\a.CQ ~. 61)
In W!1E1t capacity are you acting?
Search and
Certified Copy
O Fee$'O.OO
per copy
A Certified T1':3nscript includes all of the items of irlformation
Occurring on ,,-,e original record of me marria"e.
A certified TranScript may ~ needed where proof of
parentage and certain other detailed information may be
required such as: pUSports, veteran's benefits, court
proceedings, or settlement of an _tate.
Name (First)
of .1_
8ride rG\.4.\l~
Bride's Age
or Date of
Birth
Residenoe
of . L,.. ~
6ride "b' C-~ 8.::>
If Bride Previously
Married. State Name
Used at TMt Time
Place Where
Marriage Was
P<<formed
(State)
~.
What is your relationship to person wnose record is reque~ted?
I~ self. state "self..
Se l +-
If attorney; Name and relationship of your client to per.ons
whOSe marriage record is require~.
Add of Applicant
,(p t 6 }(T. q P
\PCt~p. f'IS rv .4
1 "d-6<J 6
DOrl.J01 (3/93)
(P-1(P-c~
Please Print name and addf"e$$ where record is to be sent.
~q 4 f\t\on d f"C\. Vl-\ e( I) u.)
K.. I 3 f?:T "'l j)
V\:):::{.
1 ?.S-9~
(PLEASE SeE REVERSE SIDE)
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~ () 1 'Ro......h: 5 :J-
r ( .5J.,. \"" i ) \ N\.{ l.:l ~ :L.i.f
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Art- 1"1 '. IOwV\ CLR...r k.') Gl.{.~~
0r09!289v8
[;:::ET 900G/9T/90
.-
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;/:i;;
02004 LlBERlY ENTEAPRISES,4DfNC
Date: May 17, 2006
~CE-\"E-Cl
~ 1~
'^~ 1"
..f\.'~ C\..~'i\'f...
,0.....
To: Town Clerk ofWappingers
From: Allison Margaret Campilii Sapp
Subj: Copy of Marriage License/Certificate
Please allow this letter to serve as my request for one copy of my marriage license (with
an official seal). I have enclosed a $10.00 check for this service.
Wife:
Allison Margaret Campilii Sapp
Date of Birth: May 14, 1969
Maiden Name: Campilii
Husband:
James Hilbert Sapp II
Date of Birth: December 23, 1966
Married:
October 21,2000
Marist College (Poughkeepsie, New York)
My husband and I were at the Town Clerk's office on December 26,2005 and picked up
2 copies of our marriage license for adoption purposes. Our adoption agency is now
requiring a 3rd copy.
Please mail the copy to:
Allison Sapp
7000 Baywood Drive
Roswell, GA 30076
If you have any questions or concerns, I can be reached at (404)-828-7449 (Monday-
Friday from 7:00 AM - 4:00 PM) or via email atasapp@ups.com.
Thank you!
/} /1
J/JA~ C.'
(/j
\ .'
~lp
.I
,y
TOWN CLERK
CHRIS MASTERSON
cA/
j:i~0
DATE
TO
FROM
TOWN OF WAPPINGER
tD ,{fl
~11 f
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
The Following Fax Message Consists of ,~
Including Cover Sheet
FAX TELEPHONE NUMBER (845) 298-1478
'MAt ~
F~ 7n.~
~ t)t) C:.
.I/I~{
----:-- ) 1.Lb."
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V- ~ 'ht~
REFERENCE
pages
SUPERVISOR
JOSEPH RUGGIERO
TOWN COUNCIL
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
ROBERT L. VAL DATI
~~)
IF YOU DO NOT RECEIVE ALL THE PAGES, PLEASE CONTACT
SENDER IMMEDIATELY.
Sender:
d,~;/",-<:.- -
flM
/k-
II'
May 3, 2006
Erin M. Glendenning
Regional Marcom Manager
Dear Ms. Glendenning:
We have received your request for 5 certified copies of your marriage. A
certified copy of marriage is $10.00 per copy. Please send a check in the
amount of $50.00 made payable to "Town of Wappinger". As soon as we
receive your check, we will mail the certified copies to you.
Please include an address as to where you want the copies sent. We cannot e-
mail them to you.
Mail check to:
Mr. Chris Masterson, Town Clerk
20 Middlebush Road
Wappingers Falls, NY 12590
Sincerely,
Sandra Kosakowski
Deputy Town Clerk
Sandy Kosakowski
From:
Sent:
To:
Subject:
Chris Masterson
Wednesday, May 03,200612:39 PM
Sandy Kosakowski
FW: Copy of Marriage License
Chris Masterson, Town Clerk
Town of Wappinger
20 Middlebush Road
Wappingers Falls, NY 12590
845-297-5771 Office
845-298-1478 Fax
-----Original Message-----
From: Erin.M.Glendenning@grace.com [mailto:Erin.M.Glendenning@grace.comJ
Sent: Wednesday, May 03, 2006 11:28 AM
To: cmasterson@townofwappinger.us
Subject: Copy of Marriage License
Hello Chris,
I received the official copy of my marriage license in the mail, thank
you for that.
Can I get 5 certified copies of the marriage license? The license is for
Andrew William Downing and Erin Mary Glendenning.
Thank you for your help.
Erin Glendenning
Regional Marcom Manager, Europe
Phone: 617-498-4590
Fax: 617-498-4314
Email: Erin.M.Glendenning@grace.com
1
****************************************************************************************************
* *
t TRANSACTION REPORT *
* MAY-03-2006 WED 04:14 PM *
* *
* FOR: WAPP. TOWN-CLERK 8452981478 .0.
; SEND (H) ~
* *
* DATE START REeE I VER PAGES TI ME NOTE M# *
* *
* MAY-03 04: 14 PM 16174984314 2 23" OK 81 *
* *
****************************************************************************************************
""'"
.....,/
Dutchess
County
Office for the
Aging/ CASA
William R. Steinhaus
County Executive
Aging
(845) 486-2555
Fax (845) 486-2571
CA.S.A
(845) 486-2575
Fax (845) 486-2599
27 High Street
Poughkeepsie
New York 12601
John A, Beale
Director
(YIAe~/A Got:
-
Date:
Lrl)~/t?6
I, ;~ 0 (if 'ev- '; c /,
(applicant' S name)
r;. I
Authorize D (A. v- I.n (~( ~
(representative)
, ' ') !,
j C'-IA' OtlV-iI'\l (
1'">
D C\.lN\b i V\.~
To act on my behalf in matters pertaining to Food Stamps, Medicaid, SSI, HEAP,
Medicare and/or Health Insurance, and other public benefit programs. I further
authorize him/her to gather necessary documentation for these programs,
;;~ I / "
" f., /
,. // /.' '/
Signed: f~' &I A, ~, t4l.-').-L ']./ {~~~
/1 ,/'7
Signed: ~L' U''-~~, ~
(representative)
//l.~ ...
,..8 Ci.... ,_' ~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
~'
Application to Town ClerklJY
for COe}' of Marriage Record
..................,..................................;...............:......................,....'.........................
.................'............................,.........'................................................................
.......................'................................................................................................
ii!~!!i!!ii[j[jijiiiiiiiiiiiiiii~jii;i!:~iiiiiii[ii:jjiiiiiiii~;~;~~~~,:~:::::::::::
.... .... .::j::IIII::::II.:I:lgll:I:..III~III::(IIBI::.III~:.i::::.:j:::.!/:::/:::/:/ ... ..
................-........................................................,......
. . . . . . . . . . . . . . . . . . . . . . . . . . . .. ............... ........... ...
.......,......................................,................................................,......
.................................................................................................................................................
......................................................................
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
.................
.................
.................
.................
.................
. . . . . . . . . . . . . . . . .
.................
. . . . . . . . . . . . . . . . .
.................
. . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. , . . . . . . . . . . . , , . . . . . . . . . . . . . . . . . .
.:..::::.~:.i$I:!::_lliIE::::~_III,:!::..I:!::fo;'nt:lli!.: ...
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. . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . .
..........................................
................................".......
............""."....................
. . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . .
..........."".""..............
.................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,
. , . . . . . . . .. ....................
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.
........................
.......................
........................
. . . . . . . . . . . . . . . . . . . . . . .
........................
. . . . . . . . . . . . . . . . . . . . . . .
..... . ..............
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits.
PLEASE PRINT OR TYPE
Name (First)
f f1... ,-
~room (lVI
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered / '). _ 0 0 () Ii
by Search v 1
Place Where
License Was 110
IssuedW V\
43
(County)
t..,d t5-( fL
/ /- Zt - h ~
(State)
/\/
For what purpose is information required?
[OS +-
In what capacity are you acting?
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) V)
~
~
~
If attorney: Name and relationship of your c1i
whose marriage record is required.
7Jf' ~(I~1l
/1o~l11 rufJ
~h' n t1~ /2)~~
DOH-301 (3/93)
Please print name and address where record is to be sent.
(PLEASE SEE REVERSE SIDE)
VS-34M
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe>' of Marriage Record
..........................
..........................
..........................
..........................
..........................
..........................
..........................
.......................
.....................
..................
. . . . . . . . " '" .
. . . . . . . . . . . . . . , . . .. ..,.............. . . . . . . . . . . . . . . . . . ... . . . . . . .. ........... . . . .. .......... . . . . . . . . . . . . . . . . . . . . . . .
,:.:'..:::.:.:ttIiSg::.gl:::,a:lr=ela:IJIIIJ,llg::'(IIIII"'I.l:"":::':.:::..h::::::*~
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.
~ee $10.00
~ ~ercopy
A Certified Transcript includes all of the items of information
occurring on the original record of the marnage.
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.
...,........................................................................................................................................................
.............................................................................................................................................................
::::::.:::.....:.:::::ii...:..::...:::I:~.IE::::a.~I"11,::II~~::'181:.I:If,1g::.III......
...................... ........................
. . . . . . . . . . . . . . . . . . . . . .
......................
......................
......................
...................... ... ................................
. . . . . . . . . . . . . . . . . . . . .. ..................................
............................................ ..........................................................
...................................................................
....................................................................................................
.............................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits.
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where . .
License Was ~()-. I ..., D t-. ~;~ JQrD
Issued / I /A./ 11 v ~ rv- I fl
(Middle)
(Last)
~I
\[0
(County)
VVI }z,t-uSS
~/1d-(oL\
(State)
l
Name
of
Bride U I SOl
Bride's Age
or Date of
Birth
Residence (County)
of ~. { ,
Bride UtA.: .\lV- ~S
If Bride Previously
Married, State Name
Used at That Time
Place Where /
Marriage waY10w Y}
Performed
(First)
(Middle)
(Last)
(State)
N'
o I' ~ UOtfJPt rz ' 1'5
For what purpose is information required?
j;;l 'Dl ~o... c..t.
In what capacity are you acting?
Applicant
/( MYl-e-r;-~ e. Dr
'-POLAJrt6RP5L.e) N'1 (2~03
DOH-301 (3/93)
What is your relationship to person whose record is requ~sted?
ij~~~~~~" SE(f ~
Ci..~
If attorney: Name and relationship of your client to pe sqns V I.
whose marriage record is required. - ()\J ~
I G
Please Wint ame and address where record is to be sent.
-t\\ \\Sb(j D.17 -e iol~
) l P('Yle -rr R ~ Lx-.
nKu Id~0.3
VS-34M
(PLEASE SEE REVERSE SIDE)
.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
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r:-::::r" Fee $10.00
~ ~er copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
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
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.
A Certified Transcript may be needed where proof of
parentage and certai detailed information may be
required such a ass ort veteran's benefits, court
p ceedings, or settlement of an es
~
'i::::!:.!:.[:::::::::::::::::':: ....
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (First) (Middle) (L.ast)
of ~ \'ct'ae\ 1>no.n R1rchins 1:1 of
Groom Bride
Groom's Age 5/3/~t1 Bride's Age (p/L \/'L..
or Date of or Date of
Birth Birth
Residence (County) (State) Residence (County) (State)
of N'I of N'i
Groom Bride
Date of Marriage If Bride Previously
or Period Covered \0 3 Ci8 Married, State Name
by Search Used at That Time
Place Where 1ttlls 1) l-\N) t1W A.J'( Place Where
License Was Wap{iY) Marriage Was
Issued Performed
For what purpose is information required?
.._1zL~_~~prooP-
oP- Y1 a. VV\L ct1
What is your relationship to person whose record is requested?
If self, state "self."
sa-P
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applicant
~4.~.
Address of Applicant
L~nn itt('~in~~(
10 Map\e- TrtL ~
~ok. 'e\J C-T t)~'04
Date
3/2..8/0 (,
Please print name and address where record is to be sent.
Lynn Parth,'()S!:.',
10 M~~ f'i'"'L Ra
'Broo,l.li'elt7J LT O~ ~ oL{
(PLEASE SEE REVERSE SIDE)
DOH-301 (3/93)
MAR 3 0 2006
TOWN CLERK
..
cO'~
~-r ~
bacl -7
RE.CE.\\IE.O
\t\~R 1 t\ 1Qt\6
,OWN CLE.RK
t4
DRIVERIS
LICENSE
Connecticut
hltp;l1dmvct.org
LICENSE NO. CLASS
:\. 18"7299673 2
,u1'ARCHINSKI, I...~ ,., .
II 10 MAPLE TRe, RD
BROOKFIELq i
DB 06-1 972
SSUED 04-2 02
ENDORS
RESTR B
o
2
5
EXl'IRES
06-11-2006
06804
HGT 5-01
<-^'
';Ill"
~l:<t1;
_ J>>~jiJ;;:~
~~
~
"111111111111111111111111111111111l1li11111111 11111111111111
COMMERt;IAt DRIVERS L1CE;"lSC
A - Comb. veh. W/GVWR >26,000 w/vell. inlQw ,,1 O,OUO G'.'Wr~
B - Single veh. >26,000 GVWR wlveh. in tow :siO,OOO GVWR
C - Single veh. <26,000 GVWA wlveh. in low 0;10,000 GVWH
NON-COMMERCIAL DRIVER'S LICENSE
1 -- Non~Commerciat Including w/veh. in tow> 1 0,000 GVWR
2 - Non-Commercial but only w/veh. in tow s;1 0,000 GVWA
M - Motorcycle
RESTRICTION CODES
B - Corrective Lens
C - Mechanical Aid
o - Prosthetic Aid
E - Auto Trans
F - Outside Mirror
F;"'[Of-.~E-;'t1ENTS
H - Mazm3t
N ~ Tank Vehicle
P - Passenger
S - Schoof Bus/STV
T - DoublelTripJe
X - N & H Combined
G - Limited to Daylight Only T - Taxi / Livery
K - CDL Intrastate Only U - Hearing Aid Req.
L - Vehicles w/out Air Brakes V - Activity veh. and
Q - Any CDL exempt veh ~ 26,001 veh, listed under T
excluding rec. veh. W - Medical Waiver Req.
R - No Limited Access Roads Z - School Bus COL Only
I am 18 years of age or older and I wish to donate the following:
o Any Organ or Tissue 0 Only the following Organs and TIssues
Donor
Witness Witness
You are encouraged to speak to your family about your organ and tissue donation decisio!-J.
You must notify the OMV of address changes within 48 hours'- Obtain a sticker at the OMV or a
police department. Print your new address on the sticker and place the sticker in this area.
Date
.
Lynn Parchinski 10 Maple Tree Road, Brookfield, CT 06804
March 29, 2006
RECE\\lE.O
M~R ~ 0 LOOO
10WN CLERK
Town Clerk's Office
Town of Wappingers
20 Middlebush Road
Wappingers Falls, NY 12590
Hi Dot,
I would like to request a certified copy of my marriage certificate so that I can
renew my US Passport. This documentation will show proof that my name has changed.
Groom: Michael Brian Parchinski
Bride (maiden name): Lynn Anne Keicher
Date of marriage: October 3, 1998
Place where License was issued: Wappingers Falls Town Clerk's Office
Place where marriage performed: St. Mary's Roman Catholic Church, Wappingers Falls
I have enclosed a $10 check to the Town of Wappingers as well as a copy of my current
Connecticut Driver's License.
Please send the certified copy of my marriage certificate to:
Lynn Parchinski
10 Maple Tree Road
Brookfield, CT 06804
If you need additional information, please feel free to give me a call at work:
914-934-2600 ext. 253
Thanks in advance for your assistance.
Best wishes,
~~.P~
Lynn Parchinski
enclosures: $10 check to Town of Wappingers, copy of current CT Driver's License
+ tbvm ~ -~\
11/3e/2ee5 14:12 3866775495
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Calvary Christian Center
1687 W. Oraada Boulevard
Ormond Beach, FL 32174
PHONE: 386-672-6571
AX: , 386-877-6495
Fax Coversheet
To: Fax: 1(15 - ol"!? - / $//c?
From: EVff,.! t?eD~wS w-, . Date: I J ,/ :so./oT"
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NEED PRAYER;'
CALL THE ASSEMBLIES OF GOD
NATIONAL PRAYER LINE 1~800-4-PRAVER
HI 39l;;'d
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96P9LL998E Z!:P! 9~~Z/~E/!!
Application to Town Clerk
for COe>' of Marriage Record
::!.:i::..i.:.II:.!g:I.B:IIIB:Q::i!li!~lgli<gllml.:.11i).!.ii..::::::??::::
NEWYORK 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.
................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
................................
................................
................................
................................
................................
................................
................................
................................
................................ ...............
.......................,........
.............................
..........................
......................
....................
......."........
Search and
Certified Copy
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.
................................................................................................................................................................
.:.:.:-:.:.:-:-:.:.:.:-:.:.:.:.:-:.:.:.:.:.:.:.:.:.......:...:.:.:e:.:.....:.a;.......-:-:-:.......:rij:i......"l::::......-:...............:.:.:.......:.:.....:-ti....:....-:-:.:.....:.if...-:.:-:.g........:.......:g.....:.................:.:.......lii!i(.....:.:.:-:
::t::::!pU~J.l91::!QW:Me4SmE:mFl)riM:::lr~q::.:Ji.:m:!:isl:m
....................................................
................................................
.............................................
...........................................
........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
...................................
. . . . . . . . . . . . . . . . .. ........................
.................. .......................
.................. ........................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................. ........................
.........................
. . . . . . . . . . . . . . . . . . . . . . . .
..................................................
............ ...........
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits.
PLEASE PRINT OR TYPE
Name (First)
~room SON
Groom's Age
or Date of
Birth
Residence
of
Groom W,<' Hf. S c;
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
(Last)
c
N~L-lJS
03-0Co-
/ C} TO
(State)
(County)
y
II . Jt)'. () I
For what purpose is information required?
~_fJ,S
J
~<<';~N C;;J4<<O
In what capacity are you acting?
12&o~
DOH-301 (3/93)
Name (First) (Middle)
of
Bride '5 fFCPHIfNT12 5
Bride's Age
~~r~ate of 02 -I q - 7-4
Residence (County)
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
P':Y OJJtJE TrE.
(State)
What is your relationship to person whose record is requested?
If self, state "self." S~
If attorney: Name and relationship of your client to persons
whose marriage record is required.
:), aO, . oOL:.
Please print name and address where record is to be sent.
$" A1v1k flS
4
(PLEASE SEE REVERSE SIDE)
VS-34M
March 10,2006
Town of Wappinger
Town Clerk
20 Middlebush Road
Wappingers Falls, NY 12590
To Whom It May Concern:
This letter is to request a stamped copy of my marriage certificate. The information is as
follows:
Date of the marriage was July 17, 1993.
My maiden name is Hanzi, married name was Young.
My mother's maiden name is Gottfried.
Enclosed is a check for $10.00. Please mail the certificate to my address:
3460 Kingsboro Road, Apt. 419
Atlanta, GA 30326
If you have any questions, please contact me at 404-869-8472 or shanzi33@comcast.net.
Thank you,
~af1clA- f ~.
Sandra C. Hanzi
",€.c€.\\J€.O
~~~ \" 1.~~~
~M~ C\..Ef'~
,0'-,"
f\ECE\\JE.C
",~R \\ '2. 1\)~
\O~M C\i.~
112 Marlow Drive
Jackson, New Jersey 08527
February 27,2006
Mr. C. Masterson
Town Clerk
20 Middlebush Road
Wappingers Falls, New York 12590
Dear Mr. Masterson,
I would like to obtain a certified copy of our marriage certificate:
Barbara S. Montague and James S. Walters (or may be J. Stephen Walters)
Date of Marriage September 11, 1976.
Enclosed is a check in the amount of$12.00 to cover the $10.00 fee indicated on line and
$2.00 additional should there be additional fees for mailing.
Your prompt attention to this matter would be appreciated.
Thank you.
Yours truly,
~~ J ~j~
Barbara S . Walters
Ph '13;:;2. . .;2.'75- 'B"I04-
. enL
TOWN OF WAPPINGER
~-
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
JOSEPH RUGGIERO
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
ROBERT L. VAL DATI
March 2, 2006
Mrs. Barbara S. Walters
112 Marlow Drive
Jackson, New Jersey 08527
Dear Mrs. Walters:
Enclosed is your $2.00 change. A Certified Transcript of Marriage Fee is $10.00.
We are not allowed to accept additional fees for mailing.
Thank you,
Q~~~
Deputy Town Clerk
Town of Wappinger
tJ
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co~ 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.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
r-Y' 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.
. ....,'.... ..........,......."..,.... ......... .....,.,....'.."....................... ....."... ," .... p.....'.'...................,. .... ... ... ..... ... ... .... .......,...... . , ................. .....
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.......................,............................................................,......,................. ............
PLEASE PRINT OR TYPE
Name (First) (Middle)
of r ,.J I. \
Groom '. l.A. wa r
Groom's Age
or Date of
Birth
Residence (County)
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Last)
S' Gl(f~ki
(State) .
Name ~First)
of
Bride OJ'h ty\ L.e e
Bride's Age I
or Date of Ii Ll I.D
Birth 1 J -, (tJ!
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle)
(Last)
[i!dretlt;
(County)
(State)
For what purpose is information required?
In what capacity are you acting?
G'S~
Address of Applicant 1"\
~(o S, (0rco ~5,&e Uf.
R()~a.\1 NJ Olflo(o
DOH-301 (3/93)
What is your relationship to person whose record is requested?
If self, state "self." $"' e.. ~-F
If attorney: Name and relationship of your client to persons
whose marriage record is required.
ddress where record is to be sent.
(PLEASE SEE REVERSE SIDE)
,.
...
,., Mot~r Vehicle t~,r'[' NEW JERSE'V
~ ServIces ~.;;;" _ ~O-'ACTlNGDIRECTOR'
r - ~ ~ DIVISION OF MOTOA VEHICLES
OPERATOR L1C. 08023 73273 54684
CLASS 0 AUTO ENDR: RESTR:
DOB EXPIRES
04-04-1968 10-31-2006
TAMMY L OSHEA
36 S BROOKSIDE DR
ROCKAWAY NJ 07866-1032
SEX F EYES BLU HT 5-11 ISSUED 08-26-2002
RP200223808277901 REN 16.00
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coer of Marriage Record
:UCUUffiMPE:a:FRE(JOFhjiisIREmtGhkQ:jC<<>
....%qq ..... qqqqqq.q.. .... .. . ..... .. . .. .... ..... .. .... .... . .. ee .q. Ae ...........q.
.... .... .,................... ............ ":-:;:::::;:;:;:;:;>:::;:;:;:;:;:;:;:;:;:;:::;:;:::::::::;::-::::;:;:;:;:;-::;:;:;:;:::;-::;:;:;:;:::;:;:;:;:;:;:;;:-:-::::;:;:::::;:;::-::::::;:;::-::::::::::;::::.;-::::;:;.;.;:::::::::::;.::::::::::::;.;.::::::;:::;:;:;:: :\:;::::-:::}::-::::;:::;::.;::-:}:;:;.;::::}:;\:/..};::::;;:;:-;......
Search and D Fee $1 Search and . CQ
Certification 0.00 Certified Copy Fee $1 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurrrng on the original record of the marrrage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marnage occurred. proceedings, or settlement of an estate.
.... ............ ..... .....
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..................................... '.' ..... . ..... . .. .. ... . .... .. ... .. . .... .. .. ....... ... .................
........... ....,...................... .. ..... '" ... ." ... . .. . ..... ...... .........
:::::::::::::;:::::::;:::;:::::::;:::;:;:;:::;:;:;:;:::::::::::;:::::::::::::::;::.:.:.:::::.:-:::.:::::.::::;:;;:::-:.:.:::::::::::::::::.:::::;::::::;;;:;:;:::::;-:::.:;;.;:;;:;::;.::::;.:.:.;;::::::::;::::::::::::::::::::::;:;::::::::::::;:;:;:::::;:::;::.;;;;;::;;:;:;::::::::.:..-::-:.:.:.:.:::-:;:-:.:::::;:.:::;:::...:.:.:.......::::::.:.:....
PLEASE PRINT OR TYPE
Name (First) (Middle)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Last)
Name (First)
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previ usly
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(State)
(State)
For what purpose is information required?
;J/.o/t1/L.,r
What is your relationship to person whose record is requested?
If self, state "self.",;;, J,e--
.
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
A:Cldress of plica)!'! /2 /. /
/1 hi/I /~~e /r//t/q r
[t/c1///fJCJlh~AO/ 4s-fc
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe}' of Marriage Record
<i.mlll!~agiIBIIII'f:tlg(I~19~@n.1>><
Search and 0 Fee $1 Search and C\J
Certification 0.00 Certified Copy Fee $1 0.00
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurnng on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
<1~~liliIMlggTI~IIM~I~BIMlllgl<<
'" ... ",' ..... . . . .... ....... .,.... .......
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~.,...............................,.".........
......-.............. ..................
..........................................
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. ..... . ....... ...... '.'........................~........
PLEASE PRINT OR TYPE
Name (First) (Middle)
of '"
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered I
by Search
Place Where
License Was
Issued
(Last)
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)
<6)-
(State)
! . \
o
For what purpose is information required?
What is your relationship to person whose record is requested?
If self, state "self." 3e. \ ~
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applicant
c....." L... ........_'.
'. ' . ,
d ..// . \
Address of Appli t
\ \<\, ~n\("\~~-d"(.
\"= " ~ ~ '( \ \\ ;J 'I
Jd S.-J-Y
Fe. 'o\J\C~ . 0:)' 8- 066
Please print name and ad ss where record is to be sent.
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
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.
~ Fee $10.00
ip per copy
A Certified TranSCript includes all of the items of Information
occurnng 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.
.. ""..,--..-.-..-...-.
......................... ".
... ....... ........
..........................
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...........................
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.."..-..,",.-:'-...:.:,',.-'........,....-.--'.-.....
......... -... -....... .........
...,..----...............
....., ... -.. ............
PLEASE PRINT OR TYPE
Name (First)
of R
Groom . e vy
Groom's Age
~~ate of j).6. B ~ 0 1/31 f,/
~fesldenpff v/CU/J.' {cO;:/b~Jfi/ /(
Groom e ' ~
Date of Marriage
or Period Covered L~
by Search DC\I.X ~
Place Where
License Was-r: of
Issued ) 0 L.tYl
(Middle)
1oe\
(Last)
Sas~
JI[
35 ye~
()!fJr)
MA
D {p J ;)5 jqtf-
For what purpose ~'5 Information required?
.fJtbj..__k_a VCYC6
In what capacity are you acting?
_hr- _mflfeJP_.
Name
of
Bride
Bride's Age
~~~ale of D. D, B :: () I J 0 '7 I fJl
~,eside~t1~: (Clf;PJYlit It:
Bride ca HI d ~.,
If Bride Previously
Married. State Name
Used at Thai Time
Place Where
Marriage Was C ,J..., oP PCL9"t;\ rc4':i))~
Performed ' J
(First)
A \\CI6,
(Middle)
C edt-,,&,,' Y)L
(Last)
Herll1jaYJ
55- Cjeaij-
(5lY'
HA
What IS your relationship to person whose record IS requested?
If self, state .self,.
seif
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applicant
A{;UA C '
Address of Applicant
1/ '7 W wt/IJYbjJ
IUd dnq f1A
,trvenuL.
O/~7
DOH-301 (3/93)
Date tJ /ICJ /06
Please print name and address where record is to be sent.
/pOD AfftlJ7k ~/ 'r- 7
g()f'fcn HA {)dd. /0
(PLEASE SEE REVERSE SIDE)
"
-- ~:-~ MASSACHUSETTS 0
NUMBER
S12696022
DATE OF BIRTH CLASS REST
01-07-1971 0 B
EXPIRES
01-07-2009
SASSER
ALICIA C
47 WINTHROP AVE
READING, MA
01867 ~
~
~
'0;,..
DRIVER'S LICENSE
HEIGHT SEX
5-06 F
....
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe}' of Marriage Record
.............................>..:m!~g~ffillglaQJ:lill@g~(g~.II~gm.}>H:)'.. ..
Search and D Fee $1 0.00 Search and D Fee $1
Certification Certified Copy 0.00
per copy per copy
A Certification. an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurring on the original record of the marriage.
the contracting parties. their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports. veteran's benefits. court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
..... ..... ......... ... ........ '," ... ......... ....... ...... .... .... . .... .... . ...... ,.'...... ...'.... .. .., '-." ..... .......... ....... ,.,......., ".-.. -. . ,., ....... ."....
pO ,..........,.......... .....-... ........-.. ...............................................................,..,.,.,...... ',' .........,...... ............... .............. ..............................................,...."..............-.........
...............................................................p.....U.......S...A.....S....S.....C....O.......U.......p....W.....S....$....S. ...F...O.....S.....M.. .."...N......O..........R......S.....M....I.m......p....S....S...............................................................................
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....,.................................. ..... .. ....... . . . '.' ... ... ..... ......... .. ........... ...................................................................
. ................ .. .......... . ... .' ........ . ........... ... ...... ..... ... .......... .. ....... ..... ....
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. ..........-:-:-:-:-:.:-:-:-:-:-:->:-:-:.:- ............ ....:.: .... ..... -:.:." ..:- .:. ..:-:: ':-:'.' ,,:-: :-:'.:-' ..:-::-." :.;. .:-:-: :-:-: ... ...-:-:-:.;.:-:-:-:-:-:.:-:-:-:-:-:-:-:-:.:-:-:-:.:-:-:.:-:-:-...........
..-......................................................,..'.............................................................................................,...........................,....'...........................................................................,'.',.......,'...,...... ,.
.............................................................................................................................,.............................................................'.....................................................,....
PLEASE PRINT OR TYPE
Name (First)
of
Groom ''1/1 (1 rl 0 II f)
Groom's Age
or Date of
Birth
Residence
of G 71 9
Groom
Date of Marriage
or Perl.od Covered. u..~ _"__"'.".".c:"",,,^,.~,
~~'=f=f=F'
by Search
Place Where
License Was
Issued
(Last)
G- tioL;As Hy
(Middle)
H.["p)/ AT
~ _ ~ - /94'9
(County)
P/<.t,vc[;S5
(State)
c: t. W AI Iff ,V6f.eS p1 Us
tl ' / '2- c .
Jc;;Y itf 5
(First)
(Middle) (Last)
A I3D EL J'''p~1rl SHAk./-4K8
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of "35 70 G,LLI 5
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
r-ATEJJ
S-c:P~ '7- 1'7 ;; L/
(County) (State)
5 T L Ii 1< ~ H" Ii EO- A A/
N'7"/05V7
;(/~ .5 - Ii <71
For what purpose is information required?
f.dM c L u /5 /'(' [-H'd E-/<? 5,' If I r
In what capacity are you acting?
s; c iY-
Address of Applicant
fO ' f) {) >C {-:: { J
/
J 6,^"c 0.1 .AJ 7'.(;'-'1"- t2 5o~
DOH-301 (3/93)
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.
2 _.2.-i - Z OJC:~
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 Local Registrar
for COei' of Death Record
PLEASE. COMPLETEFORMANDENPLOSEFEE...
FEE: $10.00 per copy or No Record Certification. Please do not send cash or stamps.
Name of Deceased
Cha.r lees 0"
First Middle
Name of Father of Deceased
0"<;rne5
First Middle
~~n;~e of Mo~~+ceased
Firstf Middle
PI~cr of Death
HOyne-
Name of Hospital or Street Address
Purpose for Which Record is Required
PA ),4Z.W
Last
.<RLEASEPRINT:ORTYPS............. ....
Date of Death or Period to be Covered by Search
YeJ;. )Lj-' DIP
Social Security Number of Deceased
Pit,} 1\22-0
Last
Month
(/3
IfJo
Year
Age at Death
.f; o+e-
Date of Birth of Deceased
Last
~5
Villa e, Town or Cit
County
C- I L
What was your relationship to the deceased? _L,J I ~ e
In what capacity are you acting?
If attorney. name and relationship of your client to deceased
Signature of Applicant
Address of Applicant
o i)i-J
COMPLETEFC>R.OEATHSOCCUR'RINGiAS OFJANUARVj t9.88 ...
_ Number of copies requested with confidential cause of death
_ Number of copies requested without confidential cause of death
.......PLEASEPR1NTNAMEANOAODRESSWHI$RJ;:RECORQSHOOLOBESENT.. . ....... ... ........
Name
Address
City
State
Zip Code
DOH-294A (6/2000)
.,
ii c;.-F
Application to Local Registrar
for COe)' of Death Record
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
PLEASE COMPLETE FORM AND ENCLOSEFEE
FEE: $10.00 per copy or No Record Certification, Please do not send cash or stamps,
Name of Deceased
~+6U ~
First Middle
Name of Father of Deceased
PLEASE. PRINTOR TYPE
f (' Daterf, D7th or Period to be Covered by Search
2/ /lIt /VL4 1 ,J t'~ 0 i I 9 3 S
Last
Social Security Number of Deceased
First Middle Last
Maiden Name of Mother of Deceased
First
Place of Death
Middle
Last
Date of Birth of Deceased
Of 07
Month Day
vJclfPI/v1-'2V'~ f;tLLr
Villa e, Town or City
I q J..S
Year
Age at Death
{JO
i 1 UC\Al d.2 4-'cd i3 II' Dr:
Name of Hospital or Street Address
Purpose for Which Record is Required
(c f'H(~'-( Ht' WCl!; .,~n) fcft1/:.'II".
D,.j( { r .('
. /; II t 'C",~
County
What was your relationship to the deceased?
In what capacity are you acting?
If attorney, name and relationship of your client to deceased
.s C )v'
------
...--
,...-
Signature of Applicant J,~
Address of Applicant /""'3C( t
Date
2'yl ~ lD
COMPLETE FOR DEATHS OCCURRING AS OF JANUARY 1 1988
- Number of copies requested with confidential cause of death
_ Number of copies requested without confidential cause of death
PLEASE PRINT NAME AND ADDRESS WHERE RECORD SHOULD BE SENT
P1 c k::
~jp,
Name
Address
City
State
Zip Code
!,,) te:..
;1. v"L-'
f~
DOH-294A (6/2000)
S-- - ':>--
;VI -I: S- t \- - ~ '2 &- - / &. t" eX
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e O~a9\7 ~'dO:l itl;OV-
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, i" ,~31.'II0
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______.ON--:el. "
<jGVV .'
SS3'd00'll
:10 031\13:J3'd
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
JOSEPH RUGGIERO
TOWN COUNCIL
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
ROBERT L. VALDATI
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
cOP~
January 31, 2006
Barbara Furst
13600 Marina Pointe Drive, Unit 1714
Marina Del Rey, CA 90292
Dear Barbara:
Enclosed is a copy of your grandparents marriage license. Unfortunately the year
wasn't written in.
The two marriages that took place in the book before and after your grandparents
were dated 1909.
Therefore, the year of marriage for your grandparents should also be 1909.
Sincerely,
D~::rc~
Town of Wappinger
-
'if
\,8"*' f\)~~ .
Rl~'l'O~c l)flf'pi
l)\,. RE.'l Cl' 90?9'l .
\-\1il1.a~at\)
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fkiy
J/~)/'2.005 -z)9 R6 fOI ~0
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Y6
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k Vvl)\lli W' (C{ lL, kLI' <L
W\Ctu4 c L~
tJUUVVf) cA Ju ~ 1-- v L '1 JO
h cJ-vv) ,\, ~ V)+-u.- .
tk~ c(j~'
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j~ ~ jj, t$b fz
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;. ~\1..~.:r\ - i :J
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r U 1\ c.,c.(L- l' \ ~ I t: ~ Or L ~ (1 Cf.F
\ J' 1""-
1)i1YL:L ,\\:LV c-\ - '--\ L.\ 3 ~
0i\~) i1\
5 affr fd~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coe,y of Marriage Record
m'Mllg'F'III~I.p:gfiIIBI:Qtg~'@QKgnt)<
. .. ................................................... ..,. ......................,............................................... ....
Search and D Fee $1 Search and ~ee $10.00
Certification 0.00 Certified Copy
per copy per copy
A Certification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information
under the seal of the Health Department, includes the names of occurnng on the original record of the marriage.
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of
groom. parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
A Certification may be used as proof that a marriage occurred. proceedings, or settlement of an estate.
..........................::.......u.....:...:.:.....................:.........:p~i.~lfilg:MR~lllft<:JtlMllg~IM~mfill:...............................:...).....:.:::..>................:.:.:................
PLEASE PRINT OR TYPE
Name (First) (Middle)
of
Groom
Groom's Age
or Date of
Birth
Residence (County)
~room DU CJ
Date of Marriage
or Period Covered
by Search S
Place Where
License Was
Issued
(Last)
WI U..-
(First)
(Middle)
(Last)
(State)
For what puq?ose is information required?
"j) Pt./C/tLC e
What is your relationship to person whose record is requested?
If self, state "self." s: --. ~
e LI-
In what capacity are you acting?
He) 5tq~D
(
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Address of pp cant
2c( Pi1-L-fl-TINC
Please print name and address where record is to be sent.
STIJ-ATJ,gUUj
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
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.
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.
.. ............." ... "." ...... ",.. . ... ...... ...... .................. .... ..... ...... .-.... ....... .' ... ,',"" ..... ..... ...... ......... ............... .... ......... ... ...,..... .......,",....
... ....... -.....,.,........'..' -,."......................................................... -........ ............... ,....... .".......,....... -... . .,.".....,... '. ....... -...................... "."............. .......... -... -,.....,.......,.",.",.
...........................................................p..U...S...........s...e......O...O.............p...U.......E...y....E........p....O......S.....M.... ...A.......N.....O.........R. ..E.I\I.....I.m... ...p....&:...e....................................................................................
.....-..........."..............."................ "' . ,. . .. . .. .. .... ...... ... .... ........-..........................-......................................
... .........-............................... .... ... ..... ... ..' . ... . ..... . ....................................................................
. ......................."................. .. "'-' .. ...,... . . . .. ... . ..... .. .... ......... ,. .. .... ... ... ...........-..................-.............................................
...... ................ ............. . ....... . .......... ... ...... .... ............................ ... ... ...... ....... ........
.............................. .. ... ......... ...,.... ...... ... .' ... . . .................................................... ...... .
..... .................. ..... .... . ... . .... .... .... .. ." ............. ...................................................
. .... .......... ." .. ... .. ..... . .. .. ... . .... .. .. .. . .... .' ., ~.. ... ... ..................................... ..... ...
........... ... .. ...... ... ..... ... .. .. . ... , .. .... ............................ -....
..... ... .. .... .... ". .... ... ,.. , .. .' .... ." '," ... .........................
........ ...."".., ............,.... .... ... . ...', ... .......... ","'" """'.' ............ ,....., ........ ....................... .
......."..".".........................,.......,..............'............-. .....,....... ................. ........,...,....,...,............ .
..........,......................................................................~..........................................................,.. ,.
. ...........,............................ ............... .........................,...,.....'... ,.
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
YCUrllc
I'd-
II
In what capacity are you acting?
rWf- $V~
(Last)
fi tuAu1
'1D
(State)
/VJ
(First)
(Middle)
V--)Last)( ma{ dt )
If l/'n1aM (,{A
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 rrO.l1/71
Performed I ~,.~
;)-
J~ /1~
(State)
(County)
Ul1i
What is your relationship to person whose record is requested?
If self, stale "self," S2A-J
If attorney: Name and relationship of your client to persons
whose marriage record is required.
ureofAp lican(:;! ro~
ress of A icant vJ d
h 5j?Yl VI. C(JI?JV' '^- Ie... '
~rr1~nr{t( ;f/.:J D 1lJrl
DOH-301 (3/93)
Please print
(PLEASE SEE REVERSE SIDE)
Christina Otero
2923 Manor Street
Yorktown Heights, NY 10598
January 5, 2006
/I;1JJ I ^
/"V (. 0 \j/
\" O)~.
Town Clerk's Office
20 Middlebush Road
Wappingers Falls, NY 12590
To Whom It May Concern:
This letter is to request a copy of my marriage license, which was filed for in the Town of
Wappinger. My maiden name is Christina Wihlborg. The local register number on the
license is 154. The date of marriage was December 23,2005. Enclosed is a copy of my
photo identification and a check for ten dollars made payable to the Town of Wappinger.
Please mail the marriage license to the following address:
19 Wedgewood Drive
Annandale, NJ 08801
Thank you for your assistance.
Sincerely,
C{ULMknlc 0 jQ)w
Christina Otero
.-
10: 993 226 718
ClASS 0
I r';h fY.. Lu~.tV\/
WIHl8ORG,CHRtSTINA.M
3 MANOIt STREET
OWNMGH18,tI'f 10598
8: 02-1246
SEX F EYESSR HT 5-04
f NONE
R B
ISSUED 08-28-05 EXPIRES 02-12-08
86740530