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2004
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe>' of Marriage Record
.;!.rnI1BIQE;':I'@~IB~III"II.g'~II~qH'II:!l :;:::::::::::::::::::::::;:::::::::::::::::;:;:;:;:;:::::::::.:.:.....
...... .... .............
?ttf}ii/;i!i;i;t~;m;)r)ii!i}!in!i!i;i!iJ;i?;{\j)iC!i!j!i!i!i?!ji;!i<ti>~~>::::::::::...
Search and ~ Fee $1 Search and 0
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.
...... ...-................. ............. ...... .....
........................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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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) (Middle)
of
Groom
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)
Name (First) (Middle)
of
B~e L G
Bride's Age
or Date of
Birth b 'Y. Jj 7
Residence (County)
of Cl.lm.8ElfU9Jt)j)
Bride; ~5 C/tlfJ./St 2 /J,..
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
(State)
(State)
/lJ..r.
For what purpose is information required?
,v. ::r. D/?IJ,I~AS J../r.
What is your relationship to person whose record is requested?
If self, state "self."
~~ I;::
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
I
Address of Applicant
Ao, d~ /poS
..D~ 7J~.
&J8'3/;
~ ~ 0 ~
Please print name and address where reco d 's to be sent. ~ ,Q
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DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
V VS-34M
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
~plication to Town Clerk
for ~oeY of Marriage Record
............................................. ........................... IMII.~ffiBggIBIII~!II;Q(!fi.sle@il.:H
........................ .................... ........................ !i!i!i!i!i!i!i!m@fiU!iUi?ii/!/i!i!i}!if)i!i!:!i!i!\W!ii)ir>i??{:::::::::
............................................. ......................
............................................. ...................
................................... ......... .................
UUH%fW/Jit)ifi?ifi?iWi?tf)!)fiiii?(iiifitrii;i!}fi(}iff
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.
....................
.....................
. . . . . . . . . . . . . . . . . . . .
.....................
....................
...............................
...............................
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. . . . . . . . . . . . . . . . . . . . . . . . . . .
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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 r
Groom .;: /Jla~p'C' /
Groom's Age
or Date of
Birth
Residence (County)
~room 3 ;;J,..1"f (//7 Tr v I' I &(
Date of Marriage
or Period Covered 11 tJ
by Search
Place Where
License Was
Issued
(Middle) (Last)
:t> E tf,1A' / c>
Name (First) (Middle)
of / /1 I
Bride Ce r~/d/. :2) E
Bride's Age
or Date of
Birth
Residence
of .../
Bride g ~/11 O/i/~. or 7,
If Bride Previously
Married, State Name / /,
Used at That Time {;eM /0',;' 't::"
Place Where
Marriage Was
Performed
(Last)
/.2..
o-Y"
For what purpose is information required?
What is your relationship to person whose record is requested?
If self, state "self."
Sey
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applicant
_// ~"J.... ~ ,
~~ ~&4/1?w
Address of Applicant
J ;;;- ~c?A~::.-;"'7 ",</
f?/'J ~~?j/" /OZ-J7'd
/;).. -tJ j- - 0 7'
Please print name and address where record is to be sent.
(PLEASE SEE REVERSE SIDE)
}~
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"-----...
DOH-301 (3/93)
"
- -.
TOWN CLERK
TOWN OF WAPPINGER
20 MIDDlEBUSH ROAD
WAPPINGERS FAllS, NEW YORK 12590
12 /C
RECEIVED FROM g -' A./ L..,.If' /" /L..#.h --"...--'
BALANCE DUE
08020
7/"
DATE flu.... s: 2 PO 9'
$[ .to /,0J
DOLLARS
..
C-
FOR
AMOUNT OF ACCOUNT
THIS PAYMENT
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe}' of Marriage Record
:::::::::::::::::::;:::::::::::::::::::::::::::::::;:::::;:
.........................,....
..............................
......................................,...................
..............................
IIBg!!IIBggiB.Q~li~llg:(I~~ql.lnrl.::..(>:}....: ...............:.....:......
Search and . t.t 11i ~ rtJ
Certified Copy t tJV' bY Fee $10.00
tf ID · per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
...........H.................
.............................
..............................
.............................
..............................
.............................
..............................
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..............................
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...........................................
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... .... .... ..........
. . . . . . . . . . . . . . , . . . , . . . . . . . . . . .
.............................
................................'..........................
...........................,..
Search and
Certification
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
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.
........... ....
..........................
. . . . . . . . . . . . . . . . . . . . . . . , .
..........................
...............,........................................................",................................................................ ,...............-.........
...... ..... ......:i:!:.:.@li\l...::~~g~.I::::II.I:.II@..:R:@lllff@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 W fJ'iA/Z-
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)
8 It e. rbLt(
:2 J6//9b'l
(County)
0'17CI/L.55
(State)
4.X
5)5/92
5
For what purpose is information required?
::L .oEA..IT/nc41'/v~
In what capacity are you acting?
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride !J t.-1 I L-
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed RiP
(First)
(Middle) (Last)
'f7/ N L
2.
(State)
:.5
IV
What is your relationship to person whose record is requested?
If self, state "self."
5ELr
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applicant
.(j
Address of Applicant
8 l/tJOcJOLAA..IO (' (
tJ,4IP,Na"e5 ;::::14['-5' /if):
125
DOH-301 (3/93)
/1 11 ZO(}
Please pri t na e and address where record is to be sent.
g ~ Dl5>D 1,4.,1 a L I
j"JA I' PI...) 6L(! S M-L-L.5 A/)(
/25<7CJ
(PLEASE SEE REVERSE SIDE)
VS-34M
Born
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111111111 rllll .....
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NEW YO~K STATE DEPARTMENT OF HEALTH
OFFICE. OF VITAL. RECORDS
, ALBANY; .
":CEiltlFICATEOF BIR;rH, ~~PI$TRA TIPH.
Zv~: "13 ;;;::;:~ a hirth certific"", has. heen filed far
Ofl ~I'~"'-'.', /~ 11" y- , at
~ ar /
~~.~
"'.: '_"~_~_n_______
E/fRGE J2
~
LJIt,Y ;J E'
S/5/ /?f:er-
S/5//r;'1/
Son
Daughte4" oj
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(maiden name of ni~ ,4
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. ", \'4' DRESS 7""''''~
JmmuDi.ed against smallpox
-'Date'
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.j.' ..... r./;"..,,,,,.I .~- 1 ~ /.. Y::-
Filed' ;'-:"-"I,t:;-~'Z:."", >J-.,.. , 1II
Immunl>ed against tetanus
c-,_,,,_,,,,~...--_.~...._
Immuni.ed against dipJ>theria
Imm,unbed against poliomyelitis
Immunized .gMinst
I
, N. Y.
and
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THIS CERTIFICATE IS EVIDENCE OF AGE, PARENTAGE AND PL.ACE OF BIRTH AND SHOUL.D BE CAREFULLY PRESERVED
Ask the physician or clinic to flU in th~ 'pace. below when the child Is immuni.ed.
Date PlIyaician 0; cHnic' "
, ' -', , I 1 ! ~::, " ,.
'1;
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I
,
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe)' of Marriage Record
..................... ....................................................... !rnlll..ilt;B:liIB:glgl~llg:!IIDIII!iJii.!
..................... ............... ..............................................................................
. . . . . . . . . . . . . . . . . . . . . ::{::{{~)t/??t::)i:}r;:;:}(?:>::::::::::;.:':' .
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:;:::::;:::::;:;:::::::::::::;:;:::;:;:::::;:;::::::::;::::;:::::::::::::::;:;:::;:;:;:::::::::::;:;:::;:;:;:;:;:;:;:::::;:;:;:::;:::;:;:;:;:;:;:;: ..................................
............................................................
................................................
....................
..................
Search and D Search and D
Certification Fee $1 0.00 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 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.
..................................................................................................................................................
......:.:..<::,..:........ :}::::::::::::.;::!:;i!_:U...!:!;aIlRlllffi!;!il~81!!!!INI).!!B:llm:ifil..!!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)
of
Groom
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)
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)
(Last)
(State)
~- ('"3~ '5
(County)
I
(State)
In what capacity are you acting?
/0- J...O - CJe/
Please print name and address where rec r
(PLEASE SEE REVERSE SIDE)
QO/ VS-34M
4 \u.'
DOH-301 (3/93)
.
~
GERALD A. VERGILIS*
KENNETH M. STENGER
ALBERT P. ROBERTS
LOUlS 1. VIGLOTTI
JOAN F. GARRETT**
THOMAS R. DAVIS
EMANUEL F. SARIS
VERGILIS, STENGER, ROBERTS, PERGAMENT & VIGLOTTI, LLP
ATIORNEYS AND COUNSELORS AT LAW
1136 ROUTE 9
WAPPINGERS FALLS, NEW YORK 12590
(845) 298-2000
FAX (845) 298-2842
OF COUNSEL:
lR.A A. PERGAMENT
LEGAL ASSISTANT:
AMY E. DECARLO
e-mail: VSRP@BestWeb.net
POUGHKEEPSIE OFFICE
276 MAIN MALL
POUGHKEEPSIE. NY 12601
(845) 452-1046
KAREN P. MACNISH
KEVIN T. McDERMOTT
STEVEN K. PATTERSON
JAY B. RENFRO
. ADMlTfED TO PRACTICE
IN NY & FLA.
"ADMlTIED TO PRACTICE
IN NY & CONN.
PINE PLAINS OFFICE
2990 CHURCH ST.
P.O. BOX 21
PINE PLAINS. NY 12567
(518) 398-9857
ADDRESS REPLY TO: ( ) POUGHKEEPSIE
( ) WAPPINGERS
( ) PINE PLAINS
October 6, 2004
Town Clerk
Town of Wappinger
20 Middlebush Road
Wappingers Falls, New York 12590
Attention:
Ms. Florence Hannon
Re: Groom: Thomas Burress
Bride: Carol Kurowsky
Date of Marriage: July 24, 1992
Place of Marriage: Village ofWappingers Falls, New York
Dear Ms. Hannon:
On behalf of my client, Carol Burress, please provide this office with a certified copy of
the Certificate of Marriage relative to the above-entitled matter. I am enclosing herein
my firm's check in the amount of $1 0.00 representing payment of same.
Thank you.
Very truly yours,
VERGILIS, STENGER, ROBERTS, PERGAMENT & VIGLOTTI, LLP
! ~A V\ ,/il/;?H/
KENNETH M. SJ4:NGER
KMS/alk
Enclosure
\ DY RECE\\IED
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TOWN (,L.:--
O:\FAMlL Y\Burress\2004 Correspondence\October 5.doc
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PLACE 01; REGISTRY STATE OF NEW YORK I STATE FILE NUMBER I
STATE OF" NEW YORK (THIS SPACE FOR STATE USE ONL Y)
DEPARTMENT OF HEALTH . .
COUNTY Dutchess
CITYITOWN Wappinger AFFIDA VIT, LICENSE and ~ 1/,/7
DISTRICT 1368 CERTIFICATE OF
NUMBER
REGISTER ] 16
NUMBER MARRIAGE Lo SUPPLEMENTAL FILE ~
B. HOW DID LAST MARRIAGE END? (3) Cl(DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? Aug. / 29 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? Ki YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNUlED. PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 8/29/84 Dutchess Co.. New York Ki 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true a
as to my right to enter into the m . estate.
21. SIGNATURE OF GROOM ~. nT~2~IGNATURE OF BRIDE ~
23 ~~B~f,.~~~Do~~~~OtRNci~Bg~:=~E Deputy Town Clerk
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law 911 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
r--"I 24. TOWN OR CITY CLERK . 25 A. SOLEMNIZATION PERIOD BEGINS
[ ] NAME(PRI~Ela~ne H. Snowden, Town Clerk
SEAL SIGNATURE ~Jil.u..ui l \~J.h... DATE 7/7/92 TIME MONTH DAY YEAR
\---....) M1?I~tl~DD!'6'i 324, Wappingers Falls, NY ]2590 2 :45 AM 07 08 92
STREET CITYITOWN STATE ZIP PM
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE P .
SONS NAMED ABOVE 0 E 0 0 RELIGIOUS
DATE AND AT THE T AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
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,. A. FULL NAME
FROM THE GROOM
Thomas C. Burress
FIRST MIDDLE CURRENT SURNAME
11. A. FUll NAME
FROM THE BRIDE
Carol A. Desharnais
FIRST MIODLE CURRENT SURNAME
B. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY IX TOWN 0 VilLAGE
~~~CIFY Poughkeeps ie
D. STREET ADDRESS 2] Swe~~ g~ . Dj irr s
E. IS RESIDENCE WITHIN LIMITS OF CITY OR IN'C6RPORATED VilLAGE?
3. A. AGE 48 3B. DATE OF BIRTH OC t . /
MONTH
ZIP 12590
o YES acNO
23 / 1943
DAY YEAR
4. EMPLOYMENT
A. USUAlDCCUPATIONCable Splicing Technician
B. TYPE OF INDUSTRY OR BUSINESS New York Telephone
5. PLACEOFBIRTH Willsboro, New York
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME
John Burress
B. MAIDEN NAME, IF DIFFERENT
Kurowsky
Burress
B. COUNTRY OF BIRTH
7. MOTHER
U.S.A.
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
12. RESIDENCEA. New York B. Westchester
c. CHECK ONE (STA[j1 CITY Xi TOWN 0 VilLAGE (COUNTY)
~~~CIFY' Mt . Pleasant
D. STREET ADDRESS 84 Taylor Place
HawLhorne
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE?
13.A. AGE 48 13. B DATE OF BIRTH Sept. /
MONTH
ZIP ] 0532
o YES}Q( NO
08./ 1943
DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Secretary
B. TYPE OF INDUSTRY OR BUSINESS Nynex Corp.
15. PLACE OF BIRTH White Plains, New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Karl o. Kurowsky
B. COUNTRY OF BIRTH Germany
17. MOTHER
A. MAIDEN NAME Phyllis Kissner
B. COUNTRY OF BIRTH Germany
lB. NUMBER OF THIS MARRIAGE Second
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE ANNULMENT
One
DEATH
Alice Dora
U.S.A.
8. NUMBER OF THIS MARRIAGE Second
Whalen
(2) 0 DEATH
1977
YEAR
B. HOW DID LAST MARRIAGE END? (3) iXi DIVORCE (3) 0 ANNULMENT
c. DATE LAST MARRIAGE ENDED? June / 10 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES Ki NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
6/10/77 Carmel, New York 0
o
o
DATE
by New York Domestic
25 B. SOLEMNIZATION PERIOD
ENOS AT MIDNIGHT ON:
MONTH
DAY
YEAR
A. MAIDEN NAME
B. COUNTRY OF BIRTH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE ANNULMENT
One
DEATH
09
92
(2)0 DEATH
1984
YEAR
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28. PLACE WHERE MARRIAGE OCCURRED
A.
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~GE %-- / /
SPECIFY W /1,PPI tV{l~ '1!:!!i.4..3.
S-ro IV. Lj.
\Tr.L
SIGNATURE" .
October 12, 2004
Town ofWappingers Town Clerk
20 Middlebush Road
Wappinger Falls, NY 12590
To Whom It May Concern:
I am requesting a certified copy of my marriage license. I was married on November 7,
1987 to Kevin Luis Adriano. My maiden name is Beth Van Norstrand and my mother's
maiden name is Reidinger. Please mail my requested marriage license to the following
address:
Beth Adriano
95 West Street
Colonia, NJ 07067
If you have any questions or concerns, please contact me at 212-733-7187 during the day
and 732-499-4778 in the evenings.
Regards,
Beth A. Adriano ~ ~ A'~
Date: ~~ 1:2 t LCX)-(
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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 esJ 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 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::iii::::::~:::::::::::::::::::::::::::::::::::::::ii::ii::::::::::::::::::::::::::ii:ii::::::::::::::::::::::::::::::::::::::::::::::::::_I:::_~g_g::::11I1::::II.:::I:IiII:::IIe,:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::!!!:!:!!!!::!::!::::::!:::
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (First) (Middle) (Last)
of H-. Me of /':.,
Groom ~ Bride / '-'I' r /C\C.A...
Groom's Age Bride's Age
or Date of J~- or Date of ~-J.~ \<i \..\ "\
Birth Birth
Residence (State) Residence (County)
of .IJ y. of '\)0t c\tes..s
Groom Bride
Date of Marriage If Bride Previously
or Period Covered ~LP Married, State Name eS
by Search Used at That Time
Place Where Place Where
Ucense Was \() w '^ tl~ W'A Marriage Was
Issued ' e;.. 5' Performed
For what purpose is information required?
e c-~ ? / ~ c {' '\\ e 0, \ \ ~ -1 ~ ~.
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.
Date
Address of Applicant
b ~cVtO()ihC JSe.
,VO.l C0'1 (/ G h ) )J. y. / c2 $1-.5- y
Please print name and address where record is to be sent.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
Won Hui Park
1885 Grand Ave.
N. Baldwin, NY 11510
(516)983-07114
Date: Sep. 28, 2004
To Whom It May Concern:
My name is Won Hui Park, formerly known as Won Hui Smith
Requesting a copy of marriage certificate.
Bride: Won Hui Smith
Date of birth: July 7, 1857
Place of Birth: Seoul, Korea
Groon: Chi Ping Yi
Date of marriage: June 9, 1986
Please mail to: Won Hui Park
P.O. Box 620802
Flushing, NY 11362
/'
( If you need further infonnation, please do not hesitate to call
I
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\
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Sincerely,
/ .
t~h~4~.~
Won Hui Park
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~ S.eurtty
FI'III'..
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. SlIek
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M>
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for Co of Marria e Record
:::::::::::~:~:~:~:~:~:::~::~~~~~~~~~~~~~~~~~~~~::::::::::::::::::::::::::::::~
...........
.... .....
'...............:.:.:.:.:.;::::::::::::.:::::::::::::::::::.:.:.:.:.:-:."
...................
....................
...................
....................
................ ..
.......IIII.:._:'.I:IIII:I:::III~III:::.IIIII.::alll:.... ..
...............:-:-:-:.:.;::::::::::::::;:::;:;:;:::::::::::::::::.:::::<::::-:::::::::::.:.:::-:;:::-:-:.:.:.
....................
...................
....................
Search and
Certification
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
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.
.................
.................
.............. ..
. . . . . . . . . . . . . . . . . . . . . . . . .
..........................
. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . .
..........................
.........................
.........................
................... .
......... .......
.......................,........................
....................
......:III.I::.IIIIIIII,::'IIII::::III:...B:III...III:..:....,.:1.::::::,: .. .. ..
.........................
. . . . . . . . . . ' . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . .
.........................
. . . . . . . . . . . . . . . . . . . . . . . .
................... ....
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 OJ'''' n.:J
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was tv ~ of) I~
Issued ,"r '
(Middle)
(Last)
1f Tr
(State)
(0 ,-(
(County)
u,
b"'20- 70
For what purpose is information required?
Z -e 1- J e..c. 1'" -e vJ(
In what capacity are you acting?
(First)
(Middle)
(Last)
I} l'Ytt. ,,-
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
L IU IJ/J
L
tJ~){) ~ '-17
(County)
(State)
IJV
LI,
tVd
What is your relationship to person whose record is requested?
If self, state "self."
5f ( F
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Addre of Applicant
~'-t l?e 611-r fl-\cJ I-t iU.:!o cJ
W A~f' v.. ) PifJ FA 1(,) AJ. \(
DOH-301 (3/93)
cr-2~/o~
Please print name and address where record is to be sent.
(PLEASE SEE REVERSE SIDE)
VS-34M
Application to Town Clerk
for COe,}' of Marriage Record
.:....:IIII.IIBIIIBg.III~III.<lllSili,l~j...>.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
........................................
......................-..................
........................................
............................................
...... ....... .................
...... .................
. ...............
Search and D
Cerlification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the lime the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
'rvl Fee $10.00
~ercopy
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:U:l;gli.:laeUljilil:::I.".,::IRm:I:III1:111
............................................
..................................... .
. ........................
. . . . . . . . . . . . . . . . . .
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
Groom
Groom's Age
or Date of
Birth
Residence (County) (State)
of
Groom
Date of Marriage :/
or Period Covered gj 'i 4- ;< ~ 0 4
by Search / /
Place Where
License Was
Issued
Name (First) (Middle)
of LJ
Bride ^ 'EG/ /Y.It
Bride's Age
or Date of
Birth
Residence (County)
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
(State)
For what purpose is information required?
What is your relationship to person whose record is requested?
If self, state "self."
In what capacity are you acting?
-kJ)FE" I-!U58/1N.D
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
<f. ~ &1';
Please print name and address where recor~ is to b~e:~ \ ~
(PLEASE SEE REVERSE SIDE)
VS-34M
o
4 ~~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Col!)' of Marriage Record
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.
:::::::::11:1:::::::I:::::::i!!:::::::::::::::::::::::::::::11:1111:1:11!1!:!:::!:!:::::::::::::::::::::::1:::::::::1::::111::::::::::::::1:::j:11811:1_8111.lj::&81::::1I1:::1111:::1..::::::::::::1:111:1!:::1:11:::::::::::::::::::::::::::::1:!!1!1::::::::::::::::!:!!:!:!:!:1:::::::::::::::::::::::::::::::::::::::::::::::::!:::::::;
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
~room ;)1-'
Date of Marriage
or Period Covered
by Search
Place Where
Ucense as
Issued t v' "
rJ\(
Name (First)
~fride ~Y"'\Q \
Bride's Age
or Date of
Birth
Residence (County)
of ';).r PQfe r<:::. rC\
Bride \+0 \.0Q ~ :J u rc ()
If Bride Previously
Married, State Name
Used at That Time
Place Where 1 \ ,
Marriage Was \./1 G\ bo. ~cl'..e.. ~
Performed
(Middle)
(Last)
(Middle)
C
(Last)
~roWV)
yn
y.Co ~1-r~
I - I ~~ - '00
....<.5,
(State) I\} Y
P,......k IAJt c; '5
(County)
(State)
on
c ........C\
What is your relationship to person whose record is requested?
If self, state "Self."sp \ F
For what purpose is information required?
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
" ature of Applicant
LV- ,~.
Address of Applicant
~"l- !?Q+ers ,0
\-\-Of{' Ll;-e \ I ::::s L\ f\ d I RP
Date
~ -- I Cc~ 0 L(
Please print name and address where record is to be sent.
c9-- -=r ~e~fS \"Cl
tto~lAJ{ U -::!UhC\:-1"OY) i\j\j I d S- 5.?
Jc9 S' 3
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
Certification
, /"
1\71 Fee $10.00
pJ 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.
."...,'......,'......... ",.............. ...",' """,",'" .. .... .... .. . ......... . . ..... . . "." .... ...,. ",. ........... ... .........,' ..............
.... .... ,...'......."..,.. .....,..................,.. .............................".-...........................................................,..........,........................................"................,.....-.............
, ",',', "",',',"""": :,::':::::':::.:::::::.::::.::.::::.:::::::.::.::~.fie::^':S":S'" ":':fo'i:"'M' ":"ft"'S" "~S'" ':'eAR' "M' :'::]fN' '.: ..".:.:1....&. 'M" :." t:m.::f!!S' 'E" .::::::::.:.:.:.:.:...:.:::.:.:.::.:::.:. ..
. , ....,. ">:-:-'<<"'>"::::::::::<:::;::(f(:):U::::::::H:/)):~:UU::r:~;5fti.;::<::-::.:~\j*yi.':::.::-;rn;~..-::):~f...:.:;rrn":<i:>.:-:.;.):::ti.<:<*:\>:-J<.<..<:::::::~:l]j]:]GL:::\.:::::Hu:r:::ff/::t;::::::-:-:-... .... .....
PLEASE PRINT OR TYPE
Name (First)
of ':'
Groom J.;AN\ t: L
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)
t;
OAJ03J('4
(La ::bb.
(State)
N
(County)
D 0TCKe S
C)\.f/H}O~
(First)
(Middle)
(Last)
(lufANI
Name
of
Bride CA'"flt€iUJJE
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was ~ ~ LIP ~ TO I/J rJ
Performed
E
O'2.-JO ~-J b 0
(County)
(State)
fJ
j) urcl-tE~.5
For what purpose is information required?
What is your relationship to person whose record is requested?
If self, state "self."
74P8L VJf)r1.\(
In what capacity are you acting?
A> /~~(1~~!)
Address 0 pplicant
FL K. A (lj~) fl\J't LL ~ (l.!)
WA~P rN &oJ UlU, tJ\.{ 4 L~1a
DOH-301 (3/93)
If attorney: Name and relationship of your client to persons
whose marriage record is required.
o
Please print name and address where record is to
(PLEASE SEE REVERSE SIDE)
>\> \\J' 1].,\ \~\~
A1'I1l1lld,~...flA'''.
I}
AllIn,
ReseM!
R.nk
PPC
.......eo,,~_s IdentmcatlDP Cllfd
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for Coe,y of Marriage Record
........................................ ..................
. . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..... ...................................... ..................
............. ............. .................
.... ................... ..................
..................................................
................................................
........................................... .
.........................................
...................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
:!.IIIIII:n:llln.lmllJ,III::::<II!II::lrI~:..!:!
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..................................................................
.................................................................
..............................................................
. . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.....................................................
...............................................
.............................................
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 informatioh
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
.:::..:!:::::::!.I.~IIII.i:I_Blillllll:..:llg.n.II~I:1II.':!:::::':!:::":!:"!':":!:':::"!:'::!:':!:!:'
....................................
....................................
....................................
..............................
...........................
........................
...............................
.............................
..........................
.... ..........
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 G(Q~G- (O
Groom's Age /. /
or Date of L-f l:)
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was \.v A ~ I N tiER)
Issued
(Middle)
(.
(Last) ,
rtoRELC: {
{o(o3/5~
(County)
DVi{flc5S
/0 116 74
(State)
~IV
fALLS
(First)
THER[<;A
(Middle)
L,
(Last)
/tORtLL{
/2 (z( /65
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
!.{(
(County)
1> VTCHES)'
(State)
NY
/
/
For what purpose is information required?
t'WfJ S T( { { t-
In what capacity are you acting?
+-( U )(]fTH G
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.
Address of Applicant
fo 80x s 4 (
LvArrt ~I G'ER S (N Y
/2- ~yO
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/City Clerk
for COe>' of Marriage Record
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.
ji:Ijjjj::j:::::::::ii::::::::::::::::::::i:i::::::i:::':::::::::i:::i::::i::i:iiiii:::::ii:::::::i:::::::::::i::::::::::::::::::::::::::::i::::lgl:g.:::_JlmBlll111:::III11111:::mll:::::::::::i::::::::::::::::ii:::::::::::::::::::::::::::::::::::::::i::ii::::::::::::::::::::::::i:::ii:::::iiii:i::::i:::::ii:::::::i::i::::i::::j!
PLEASE PRINT OR TYPE
Name ~First) (Middle)
of ~
Groom Ivz G,--
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
)f-rt)
((De S~
Name (Middle)
of
Bride
Bride's Age
or Date of
Birth
Residence
of / )
Bride Jl.S: ~
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(State)
/V
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?
II t( SA /-1 A~/)
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date
Please print name and address where record is.t00b sent.
. 1&1
~' ~ \1-,
\ "i\Qf
~\\J
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for Coer of Marriage Record
..........................................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . - . - . . . . . . . . , . . . . . . . . . , . . . . . . . . . . - . . . . -
..........................................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . .
'.....................................................-...................
........ ................................ ..... ...... ... ............
..................................................................,.........
..........................................................................
.......................................................-,.................
........ .........................~......................,...............
....................... ......... ..................................
...................~................................................
........ .~....... ......................................-........
.......... ....................... ............. ..............
............................................................
...............,;................................................................................................
................ ..................~.................................................. .,.............
. . . . .. ............... .................... ....
...........................................................................-....................................................
ml'egg.ffiag~IBg:QII"II~..~@III~II.il
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
P per copy
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.
...::~.b~g~:::_I~ET..:.:~I~M:..Pilq::;!B:~MI~~:I~E~:
. ..............................
.................................
................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
...........................
. . . . . . . . . . . . . . . . . . . . . . . .
.....................
. . . . . . . . . . . . . . . . . . .
.......................,...................................................
..........,......................................
................................................
.................................................
................................................
.................................................
................................................
.... .................................................
.................................
................................
.................................
...............................
.............................
..........................
. . . . . . . . . . . . . . . . . . . . . . .
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 ~'
GroomvOJY\ V
Groom's Age
or Date of 0 ~ lrJ- /
BIrth ./
Residence (County)
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
C.
~
(Last)
(State)
tJ\
To L0Y\ c~(t
For what purpose is information required?
tD C h(U}~ + ht nrLfVl{ OYI
br~ d2s ~O c iu..Q ~e c. . (1CLf d
In what capacity are you acting?
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 D/1 f JA A i tlll'.- ~ .
Marriage Was OCTY lJt.1 , r IlSS 10 Y1 . .
Performed C Vl L h
(First)
Laure..n
8g-
o
(Middle)
C
(Last)
~mlrh
(State)
What is your relationship to person whose record is requested?
If self, state "self."
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
Please print name and address where record is to be sen;
~ ~ q ~O I
~ \ 1> ~.
...\ \~~
VS-34M
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
*~c>s'f
fd... d \ u --
Application to Town Clerk
for COe)' of Marriage Record
..... ...... .....
............--.....
...................
...................
................................
...............................
.............................
........................
......................
. . . . . . . . . . . . . . . . . . .
.. .... . ........"...
... .::::.:::.:::.wle~.~:~::.:~:llla:I:III~8~g::.lgllil:::1Pll:::::..':::
:.;.'.:.:-:.:.:.:.',:.;.:.'.:.:.;.:,".:.:.:.;.:.:.;.:.:.:.:-:.:<-:-:.;.;.:-:-;...........
.:-:..:-:-:...;.......:.:-:-:.;.:.::::::::.::::::;:::::::::::::::::::::::::::::::::::::::::::;:::::::::::::...;...........
..... .............
. . . . . . . . . . . . - . . . . . .
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . - . . . . . .
...................
. . . . . . . . . . . . - . . . . . .
...................
. . . . . . . . . . . . . . . . . . .
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.
r\I, Fee $10.00
00 per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marnage.
Search and
Certified Copy
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.
:;::..;:::;:::;::::>;;:;::;:;::,:,:::,:'::::II]:e.s,'::loisCETe::!:illl:ill::!!A:EMitisi:::
......................................... ..... ............................................................... ........... ............................................: ....:....:.............................:.:.:.:.:.:................................................................'..............:.....:..'....;....':..........................:.:.:.......
..
. . . . . . . . . . . . . . . . . . . . . . . . . . .
...........................
. . . . . . . . . . . . . . . . . . . . . . .
.........................................
.........................................
.........................................
.........................................
...................................... ..
.........................................
.........................................
.................. ........ .... .....
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) Name (First) (Middle) (Last)
of tn\ Press 1 ef of 'brC(n "- (~\oClILem
Groom Bride
Groom's Age tD II~ II~ ~ '3 Bride's Age '1/'0 \ \qloLf
or Date of or Date of
Birth Birth
Residence (County) (State) Residence (County) (State)
of Du-tcruss N of J) N
Groom Bride
Date of Marriage If Bride Previously
or Period Covered :>11/ IA8 ~ Married, State Name
by Search Used at That Time
Place Where Place Where W~{l~~II~
License Was V\JaWI(1SU$ ~Ils Marriage Was ST. ~CUL{ 5-
Issued Performed
What is your relationship to person whose record is requested?
If self, state "self."
COM
In what capacity are you acting?
Sel,(J
If attorney: Name and relationship of your client to persons
whose marriage record is required.
qfqlzcvtf
Please print name and address where record is to be sent.
~lR0::'
DOH-301 (3/93)
VS-34M
(PLEASE SEE REVERSE SIDE)
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- -
DRIVER'S LICENSE
ASUNCION
JOHN A
70 EllOICOII8 ROo\D
BELFMT, lIE _6
3423243
EllPtIlES ISSUED
oeI1212008 05118/2002
EYES HEIGHT
WEIGHT SEX
195 M
CLASS C
REST.
ENDS.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe>' of Marriage Record
...................................................
....................................................
...................................................
....................................................
...................................................
... .. ............................
........ ........
...............................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
............................................
........................c................
........................ .............
................,...................................................
.............................
........................
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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.
........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
................................ .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
...........................
. . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .. ..
.....................
. . . . . . . . . . . . . . . . . , . . .
.....................
. . . . . . . . . . . . . . . . . . . . .
..................
~e$10.00
~ ~:r 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.
..............................
............................
. . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
...................
.............;.;.:;:::::;>::;.;-:::;;;:;:::::;:.
!:!.!:!:::::;;.:!.::.::::;::!I:~IIII:!:;I_lllil..::111I::.III="I:III"'III':'.:'::!'H
:::::::::::::::;:;::::::::::::;:::::::::::::::::::::::::;::::::=:::::::::.;.;.;-:-:.:.;.............
;.:.:.:-:-:-:.;.:.:.:.:.:.:.:.:.:.:.:-:-:.............
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;/r/t'~/..If'i t
Groom's Age
or Date of
Birth
Residence (County)
of ~ .
Groom ,SfIIL I
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
(Last)
f1 tXE1..o
~!~/S-7
(State)
::::r;; Ii II ! 99?
!/Jl1rAttJ7f5 hils
In ""al oapaoity are y~
c::...=
Name ~First)
of
Bride ,v MIJ
Bride's Age
or Date of
Birth
Residence
of --
Bride I- /.5 ~ '
If Bride Previously
Married. State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle) (Last)
1'1~ D
(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.
~
"792-PIiOS /'1;;) ~ /fI
r '// . /~5e21
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/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.
iiiiiiiiiiiiiiiiiiiiiIii:i::i:::ii:;;i::;::::::i:::jj;:ijij!i!!!j;iiiii:::::i::jj:jiiii:::::::j::jjjjijijji:jii::::::;::!i!:iji::::i::i:::::::!:_S:::_SW.I!i:1I11IIBli::llllijifill:::::::::::iij:jj::j:j:::::jjjijiijiijij!:::j::j::!i:!:ii:::::::::::::j!:!:j:!:iiii:i:i:iiiiiiiiiii:::::::i:iij:::::::!:::::::::::;::~::::::::j:i:i::
PLEASE PRINT OR TYPE
Name (First)
of
Groom j.e W
Groom's Age
or Date of
Birth
Residence (County)
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
(Last)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was f -f'
Performed '/O()J vt (), '
(Last)
Gi\ill~~1
(State)
(State)
/J\
Wa..
ers
For what purpose is information required?
What is your relationship to person whose record is requested?
If self, state "self." (\
Se [ -r-
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 I L
) It -(. r- <93 - --0 vr
Addre ,of f Applican . , _ Please print name and address where record is to tr, s nt.
I b r LU, dnt-t't t:2i, , J 'D
L/AJrt (lr I ns-e V r ~ L l ~ / 'f\J ~ I;) CJl -0 0
(PLEASE SEE REVERSE SIDE)
r
DOH-301 (3/93)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe>' of Marriage Record
.................
.................
...,.....:i.II:::..iB:IIII~I.III~llg:i:(llill~.:ltl1:::ii::.:;'..:
.............................................................
..............................................................
.............................................................
..............................................................
......... ................................................
..... .........................
. .. ...........
.......................................... .
......................................'.................................................
............................................
............................................
.........................................
..................................
.................
...... ..........
.................
.. .. . ......
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.
Search and
Certified Copy
~e$10.00
L:::J p~~ 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":e'....::\::C.::.:O...:.::......:':...'p....:.'C..:::=:E..::I1...:E..::.':':e..::s.:..:.::S..::.....::.':':...::..::....'.O..:..::':'...:....'e....:.::.....:'....'I.m.:....:.:::I::.:..:::..:::::
........ . ..... .... ..... ......... ..... ...... ..... .... ....... '.' .... . . .... ...... .'.
~:~:~:~::...:::::...:;:~::.;.;.;;:.:::::.::.::..:::..:.:.:~:~::.:.:.:::::.:;:.:::...:..:..:...::::~...:::::....:.:{..~:~....:.:;r...:~:~::;::;::::.:.~::.:::.:;:.:::t~...::::..:.:::...:...:::.{~~.::~::..~....:.:;...;......:..::~..,j~~~~::..:::::.,.:.:.:::.:.:.:~:
............... ........
..........................
...........................
..........................
...................................
..............................................................'.......
...................................................................
...................,....... .
......................
.............. ..
...................................
....................................
...................................
....................................
...................................
....................................
...................................
....................................
...................................
....................................
...................................
....................................
..................
......................
......................
....................
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
Residen
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Wa~
Issued OLLS
(Last)
Name (First)
of
ride
Bride's Age
or Date of
Birth
Residence D
of
Bride i 0
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle)
(Last)
(
(State)
(State)
AJ-
For what purpose is information required?
l;e.ri.~ T,p,
What is your relationship to person 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 1\\'
whose marriage record ;s required. ~ \ ~ J
/:2.6()!
;s to be sen~1 \ ~
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 CoeY of Marriage Record
i::::::::::::::::::::i:i:::::::::!i:::::::::::::::::::::::::::::::::::::::~::::::i:::::::ii:i::!:::!:::::iii:i:::::i:i:::::::::::!:::!:::ii::::::i::::::i:::.II:iiBi:illllll:i:lllllli:i:IIIII:::IRI::::::::iiiii:::::::::iiiii:ii::iii:i:::i!:::i:::::::::i:i:~ii::::::::::::::ii::::ii:iiii:i:iii~::i::i:i:::::::::::!:!::::::ii::::iiii:i:iiii:::::::::::::::
Search and D Fee $1 0.00 Search and ~e$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 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.
:ii::::::::::i::ii::i::iii::iiii:iii:::i::::i:i::::::::::::i:ii::i::::::::i::::~:::::::::iii:i:iii:iiiiii::::i:iii::i:::ii:::i:i:i:::::::::::i:i:i:eg_.:::_mWlle:i:_I:::III::::IIII:::I_I:::::ii;:::::::::::::ii::::::::::::::::::~:::::::::i:I:::::i:l::::::::::::ii:;::::;::;iii:ii:i:::iii:::::::::::::::::::i:::::::::::i:i::i::::i:;
PLEASE PRINT OR TYPE
Name (First)
of
Groom JL
Groom's Age
or Date of
Birth
Residence
of
Groom I
Date of Marriage
or Period Covered
by Search
Place Where
License Was .___
Issued I
(Middle)
th
L
(Sta~e) .
tV. \ .
Name (First)
of
Bride
Bride's Age
or Date of
Birth
Residenc
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle)
(Last)
L~
(State)
u-'
For what purpose is information required?
tJ~rl ~1 L . D .
What is your relationship to person whose record is requested?
If self, state "Self.." . ~
Se. .
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
--
0'" d-6 -' 0
Please print name and address where record isJo be
Date
ss of Applicant .
~ Penl/Ju~ K -
.( Cll~ h k :,. t" Po/e., f-1./ Y'.
J ~b()(
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:i:~~::::::i:i:::::::::~~~~~~~~i~i~i~~~~~::::::::::::i~i~~~i~i~i~~~::::::::::::::::i:::::~~:::~:~:::~:::::~:::~:::~:::~~::::~:::::::::::::::::.I:~:II:::I:IIII:I:i:IIIIII~::IIIII:::I_l::::~i~i~~~i:~:i::::::::::~:~:~~::~i~:~i:~:~~::::::::::::::::::~::~::~~::~:i::::~i~::~~~:i:i::~~:::::::::::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::::::::::::_*=:::_II.i:~~IIII::::III:::IIII:::lel:::::::::::::::::::::::::::::::~:~:~::::::::::::::::::::::::::::::::::::::::::::::::::::~::~~::::::::::::::~:::~~:~:::::::~::~::~::::::::::::::::::::
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
Ucense Was
Issued
ttJ I~ t.
(Middle)
CtJI'I c.
(Last)
Gr~{t
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 f)
Performed r 0 Ii
(State)
rI
(Middle)
VV:l/,~
tJ.,J
(State)
I
JJ
t.1
J
---
'J 1 t. I ru-, 1"11 J (j v..b
For what purpose is information required?
Co..n 'I' fA'" ^- m" '" ,.A
In what capacity are you acting?
What is your relationship to person whose record is requested?
If self, state "self."
J e1 J:.
f
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Address of Applica t
Lf t~ fJ(j,CA~
W'ffl/"l) V J A41J r1~
DOH-301 (3/93)
/').~~u
Date
(PLEASE SEE REVERSE SIDE)
TOWN CLERK
TOWN OF WAPPINGER
20 MIDDLE BUSH ROAD
WAPPINGERS FALLS. NEW Y RK 12590
DATE
,
THIS PAYMENT
.u-~
/ CZ11ank '%U
" c::h{,.L' L,....uL.
FOR
AMOUNT OF "CCOUNT
BALANCE DUE
1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe>' of Marriage Record
..............................
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. . . . . . . . . . . . . . . . . . . . .
...................
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;.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.:.;.
::::::::::::;:::::::::::::;:::::::::;:::::::::::::::;:::::::
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. ............................
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.............................................................................
...................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
............................
............................................................................................................................................
......:.:::00111....I.IIII'g.III'=.II::,:IIOII:::11I1...
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.
.....................................
..................................
. ....................
....................................... ....
... .........................
.... ........ .....
.. ......
..... ................ ............... .......... ......................... ,............... . .......................
eIEAlE' GOMPSSlmS '~'B'!J: .~....B,$Mt1t..EEE..:.:..:'
...................
....................
...................
....................
...................
....................
..... ............................. ........................
... ......................................
...........................
. ..............
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 .::1'7 }
Groom ,71.?'1,/~
Groom's Age
or Date of
Birth
Residence (County)
~room J)Vt~
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
~
(Middle)
~
;L-.g
(Last)
.g4~
5'1
')
vJlt
For what purpose is information required?
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)
,6
What is your relationship to person whose record is requested?
If self, state "self."
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
VS-34M
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe}' of Marriage Record
....................
. . . . . . . . . . . . . . . . . . . . .
....................
. . . . . . . . . . . . . . . . . . . . .
.................................
.....................................
...................................
.............................. .
...................................................
....................
.............................................. ~...................... ...~~......................,........................ ...........................................
:::::::~8E...:=6i:em:E....l:i"t,im:D.,:}~E<a'l..dl....D:./'~~~iiiiiG:)."'~\////}}
.:...:.:.:.:.;.:.;.;.:::::::::::::::::::;:::;:::::::;:::::::::::::::::::::;:;:::;;::;:;:;::::~:~:~;~:~:~:~:}~~~~rm!~~rn~:.:.::::~:~~~JJ:~:~g:;.;.;.::MMm::.:.::}~:M::.;.;.J?:!:.:g:.;.~.;.~.:.;.::::r\M~:!~~~~:~:"~:~~~t:~;~;~{:~:~;r:;~{::;::~:
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.
. . . . . . . . . . . . . . .
.................
. . . . . . . . . .' .
..............................................................................................................................................................
d:fUiGSES::ea:MII1E$E/IG1AM/IIII.:FUIM:mmeEE/::/://:://::
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........ ............
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... ....................
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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
~~~e:~~~hcovered ~ U ^E ~ ~ ~OO \
Place Where
License Was
Issued
t<J~\,)
oTI
(Middle)
c\). S
(County)
(State)
In what capacity are you acting?
Signat~~ G~
Address of Applicant
DOH-301 (3/93)
Name (First)
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle)
(Last)
(State)
5 (2w-S
What is your relationship to person whose record is requested?
If self, state "self.~ <2 IS
If attorney: Name and relationship of your client to per
whose marriage record is required.
Please print name and address where record is to be sent.
(PLEASE SEE REVERSE SIDE)
VS-34M
?J
:\\ t, NEW YORK STATE DEPARTMENT OF HEALTH
'\: Vital Records Section
Search and D
Certification Fee $10,00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom,
A Certification may be used as proof that a marriage occurred,
Application to Town/City Clerk
for COe>' of Marriage Record
~O,OO
~ ~:~ c~~y
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
.. ..... ....... . .......... .. . .... ........ ... ....... .... n. ............. ............... .
...................................."....--............................................................................................................................-.. ........-...........................................',,....,'."."'.
.......................................'................'".....,....".'....,..........,..............,..........p......C......S..Jft..'.S'..S......C.....O.....'.M"....P.....U..."'1""'$' "'I" "''''p' "'0"" "'9" "'M" ""'.''''''11'''''0'''''''''8 "".'1.".'14"..".1.*""....'.".6""6...........................'.",., "',,...."
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PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (First) (Middle) (Last)
of of SJ.~
Groom Bride P1
Groom's Age Bride's Age
or Date of S- - I~- ~CJ or Date of
Birth Birth /2- - '2-- ') - I j1t, 0
Residence (County) (State) Residence (County) (State)
of ~u/(}WtSS M/ of )) eLf-55
Groom Bride I
Date of Marriage If Bride Previously
or Period Covered 99'1 Married, State Name
by Search Used at That Time
Place Where Place Where
License Was Marriage Was
Issued Performed
In what capacity are you acting?
"
Address of Applicant ()
/ 9~ SM;/l. '/(JuJ,v !/oAIJ
hs 1I-1,jl, Nt' /ZSc5lr
DOH-301 (3/93)
What is your relationship to person whose record is requested?
If self, st~~2/~
If attorney: Name and relationship of your client to persons
whose marriage record is required.
(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 [XJ Fee $1 Search and D Fee $1 0.00
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 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
Groom's Age
o~Dateof Od --1'0 -
Birth
Residence (County)
of
Groom
Date of Marriage
or Period Covered I bl - J <:?- -
by Search
Place WherelO
License Was 0 / {} .A/l
Issued U0
(Last)
,
LtC
19 & Q)-
l
Name ..--- (First) \
of - ( Q
Bride~
Bride's Age
or Date of I C) -
Birth I {7
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was r:>
rformed ~ I
2~~ ~P/?'
(9' 9-(f)
(County)
~
What is your relationship to person whose record is requested?
If self, state "self."
In what capacity ar~y~
r;
If attorney: Name and relationship of your client to persons
whose marriage record is required.
(""
Date
r
DOH-
(PLEASE SEE REVERSE SIDE)
NEWYORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' of Marriage Record
...............................................>.........m~Ri~FBiQmBg.gll~fllgtQl1tsll".).........................Y...............}.
. ...... . .................... .................................................. ...................... ..,....................
Search and D Fee $1 0.00 Search and 0 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 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.
. ... ,........ ... ..........,.... . .....,. ..... ...... .. ... .., ,.,.. ...... ... ."" . ..... ",... ...... .. ...........- ........ . ..... ... ...
....;.;.;...:<<.;.;.;.:-:<<<<.;.;.;.;.:::.:->>:.:::.:.:.....:.:..,;.:.:......:-:...;.:.;.....;.........;.>>.'..:.:.;.....;.:,..:-:-..;..,....:...;.;.:.......:...............:.:.:.......;->....;.;.......:.....;.....;.:.:.....:-:...;.'.;....,..:.:.:.......:-:.......:.....:....,.';'......:.:.:.'.............:.......:.:.:.:-:-:.:.:.:.:.:.:.;.:.:-:':':-:-:':':-:':-:':':':':':-:':':':':'..
PCiAs.e.COMREETEfBJBM:ANQRE.MlmFEEY\Y
. ........ .......,.... ..",......."..............".,................................. ..." -.. ,....... .........".. ......................,...........
.-.......,................................... ....... ..................,............................................ ..............................
..................................................".................,..................... .
.... ........., .............
. ,.-........,........"-............
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.................,................
..................."............ .
...................,..-......-.
..............-.......-.......
...........................
...-...........-"......
.. ... ................
.............-...'...........'..,..'.'..
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered Oll
by Search I
Place Where
License Was
Issued
(Middle)
~
(Last)
~.
({ /2.[1 fltT
(St~e)
Name
of
Bride
Bride's Age
or Date of <) S-
Birth (:)
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(First)
(Middle)
..If B.&lfLccK
02/2/ ( (1 6q
(County)
Ou-kkes
(Last)
\1
'P,,,,
~,
(County)
~.\e
(State)
AJY
For what purpose is information required?
~M~t)h.A.
What is your relationship to person whose record is requested?
If self, state "self." ,\Q f
In what capacity are you acting?
l~a.j_
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Address of plicant
31S~bCM ~
l~~~lJk/AJY (LQ3
Date
($/ O)./2(JJ~
Please print name and address where record is to be sent.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
-
"MOUNT OF "CCOUNT
THIS P" YMENT
N<! 1468
1'f~7itt~ _,d!!-ft
~,~~ EIL)~
. ~ DOLLARS
U-~ tf:-
_ IJ! crIumk"X.O~
,,~. ..ILLU-<!u
TOWN CLE.RK
TOWN OF WAPPINGE.R
20 MIDDlEBUSH ROAD
WAPPINGERS ~~S. NEW YOR~590
RECEW'EO ROM (./ ~ ~
At:
f/ /~O
FOR
B"L"NCE DUE
...
..
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for CoeY of Marriage Record
....................
.....................
...................
.....................
....................
.....................
....................
....................
...................
.....................
....................
.....................
...................
.....................
....................
............. ......
......,.............-........................
..............................................
.............................................
..............................................
..................................,..........
..............................................
......-......................................
............... .... ... ....................
......... ......
.........................................
............................ .,..... .
. . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..
........ .....................
_IIQlI.IQII.li.Qil~III..i~gl@9Iilnl):.............)):.......................
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.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurnng on the original record of the marnage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
prcceedings, or settlement of an estate.
...........................................'....................................
........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.......................................
.... ........ ...... ................
.....
....... .
. .. ... .... ................. ......................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .... .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .............................
::::..ela!.I.:.gg~uE$E..:P~....:..~g::'EMllln~~.:..::.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)
of ~. . I
Groom \"'\.. ~ c.. 'v\a.. {"<j
Groom's Age
or Date of
Birth
Residence (County)
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle) (Last)
f, ?~++e ~
(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)
~ 'fT~l
(Middle)
Ft
(Last)
-P~.sT
(County)
(State)
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 Applicant
(\~ \ n. .~~~
"'-U...L 0 IJ...
Address of Applicant
Date
7- 30-{)'-j
Please print name and address where record is to be sent.
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.v of Marriage Record
Search and ~e$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.
:::::::::::~::::::~::::::~:l:l:::::::::ii:i::::::!i~:ii::::::::~::::::::::i:::li:iiiiii:~:::l:i:ll::::::~:::::::::::::!:::::::::::::::~:~::::::!:::_R:::_lm_R:::_11:::.I:::IIII~~~mll:~::::~:~::~~:::!!:::::::::::::::::::::::::::l::::l~:l:~::~::~~::::::::::::::::::::::::::::::::j~:~:::::::::::::j:l:::::::::::::::::::::::::::::::~:
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (First) (Middle) (Last)
of ~h~; ~o;h 01; do; \fY)or'~ of '"Ih A~ ~ '1/0
Groom ~ eN e- ( Bride --e.(~S " V) r
Groom's Age Bride's Age
or Date of or Date of
Birth Birth
Residence (County) (State) Residence (County) (State)
of of
Groom Rrirl",
Date of Marriage If Bride Previously
or Period Covered Married, State Name
by Search Used at That Time
Place Where Place Where
Ucense Was Marriage Was
Issued Performed
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.
---
-
Signa~ At:nt ?r; ~ Date
20 3""",- \ oll
Address of Applicant (:) Please print name and address where record IS to be sent.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
~
~ :D'
\ NEWYORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe}' of Marriage Record
:....:...II~III.II,..IBliIB:gll.i~III::(glipllgnil:.I.:.,.r::: ....................
. . . . . . . . . . . . . . . . .
........
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 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.
...............................
..............................
...............................
..............................
...............................
..............................
...............................
..............................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..............................
...............................
..............................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..............................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..............................
.. ...............................
. . .. ".. .....
............. ..................... .....-....... ............... ....... ........ ..........................................................
..........S.....U......S....II.......S.............smu.......................p.....W................S........p....(I.......S.....M........................S..........S.....S.....M................p.................................
..... .. ... . .. . .. .. .. . . .... ..... . .. .........
...... ... ..... ....." ... . ."', . ..........
. .... .. .... ...... . , . .. ... . .... .. ,., ........... .... ... ... .. ..........
...... .. .. ...... ... ......... ... ...... .... ..........
..... .. .. ...... ........ ...... .. ..... .........
..... .... .. . ... ...... ,.... " ." ....,. .... ..........
........... ......... . ....... .' ....... .... ,'. .,........,... '.'. '. . .... ..... '. ...... ..... ... ......................
.::::::::::..::::::,......:.......:.:.:::...:.:...:::.......:::::.:...:.:::...:.:::...:..:.;;;.::;:;::.:.:.:::.:.:.::;::.::;:;.:.:.:::::;...:;;:;:;.....;::..;;...:...:...;..:;::...:::...:..::...:.......:::::::.:;::.:::.;.:.;::.:::.:::;;.::;;:.;;;;;;;::.;:;::::.:.;.;:;.:.:.;;;;:;::::::::::::::
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..
....-...............................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
............................
. . . . . . . . . . . . . . . . . . . . . . . .
.....................
................ ..
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)
(County)
(State)
)jf
-:Ilt +c) .U-.J-U
J;) ~ I /';).~
-)OtJ.Jn
For what purpose is information required?
In what capacity are you acting?
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride uJLJ~
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(State)
JviY
What is your relationship to person whose record is requested?
If self, state "self."
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
Please print name and address where _"'c,>r~ to\ ~ ~1'
VS-34M
(PLEASE SEE REVERSE SIDE)
~I
f\\ '
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for Coe,y of Marriage Record
................................................ .
,............".....................................................
.-..................................................................
....................................,...............................
....................................................................
. . . .. ............................ .......... ........ .. ..........
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . .
................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ..
........................................
. . . . . . .. ..... .................. .
iilltlfill'is:lllllilllll:I"'itliI9I!'ln.il.:
r;-/" Fee $10.00
~ per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
...................
. . . . . . . . . . . . . . . . . . .
...................
. . . . . . . . . . . . . . . . . . .
...................
. . . . . . . . . . . . . . . . . . .
...................
. . . . . . . . . . . . . . . . . . .
...................
. . . . . . . . . . . . . . . . . . .
......................
.....................
........................ .
.....................
..........."......
Search and
Certified Copy
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.
..................
.................
..................
.................
..................
.................
:::frulg@:.:~gl~ETE::]~~IRM::::iID:..':E~Rii.III:::::,: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)
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 \A.)t>-
(Middle)
LOIJ : ')
(Last)
\0 ~I\S
I \o,z ( .\-
(State)
- '-"-e ~S
2- -, I C'f0
For what purpose is informati~n require~?
lo:::>~ Mw-r\(....~ Ce.~c.~
In what capacity are you acting?
Name (First) (Middle)
of S
Bride \ AV\~
Bride's Age
or Date of
Birth If .~. fog
Residence (County)
of , .
Bride OukL...v.J)
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage WM ,\ \. \.
Performed \J,,\~ T,', ,,',
(Last)
wt€.IM- ~
(State)
.JvV(
What is your relationship to person whose record is requested?
If self, state "self." S-e,f-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Jv.{
DOH-301 (3/93)
.., 2d tJ L/
Please print name and address where record is to be sent.
I .
~"JJ
'" ,:~ *' If 1t\C
~~u
(PLEASE SEE REVERSE SIDE)
VS-34M
June 24, 2004
Wappengers Falls Town Clerk
20 Middlebush Road
Wappengers Falls, New York 12590
RE:
Marriage License
1\
QV
\) l)
~O/ lot-\'
\~ ,'" \V\
Please forward me a certified copy of my 1972 marriage license. Here is the information
I believe you will need:
Susan Patricia McPadden to Narendra T. Shah
Date of Marriage: September 3, 1972.
My Social Security Number is 063-38-8474
I am enclosing a copy of my current drivers license. I have moved from the address on
the driver's license to 5554 Shepherdstown Pike, Shenandoah Junction, West Virginia,
25442. In order to have my driver's license switched to West Virginia I need to provide a
legal link from my social security card, which unfortunately, I did not change when I
married to my married name of Shah! .
I am also enclosing a check for $10.00 to cover costs. If you need anything else please let
me know. My home phone number is 304-2876-1105, and there is a recorder.
Thank you.
Sincerely yours,
~\~-~~~
Susan P. Shah
5554 Shepherdstown Pike
Shenandoah Junction, West Virginia 25442
I
SHAH1 SUSAN PATRICIA
112 EAST MAPLE AVENUE
STERLING, VA 20164-4221
FAIRFAX COUNTY
i I
II
II
I
I
I
I
I
I
I
_.1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Col!)' of Marriage Record
Search and .~ Fee $1 0.00 Search and D Fee $1 0.00
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.
I:::::::::::::!::::!:!:!:::::::::::::::::::::::::::!::::::::::::::::::::!:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::!!::III:.i:::_~I_II:~11.:::.gIIIII:::~I.:::::::::::::::::::::::::::::::::::::::::::::::j:::::::::!::::::::!::::::::!:!:!:!:::::!::::::::::::::!!::!::j::::!:!:!::!:!:::::::::::::::::::::::::
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)
Name
of
o Bride
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Plac~ Where L I{h.ONYS .&\: eCl"1
Marnage Was'\'-
Performed -+ €..iA:RJ (
(First)
(Middle)
(Last)
10 ~
(County)
(~a~pIJolJe.t? fM(S
NY w-si ()
1-1-7to
(County)
. ~eS5
(State)
J
b
/" ~
()-b-Od
I\LY:.
For what purpose is information required?
Josd. 6/C ('6 ;N4 {
What is your relationship to person whose record is requested?
If self, state .self."
5tL l-f
In what capacity are you acting?
Hu..4;wd
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date
Address of APP.licant \ J./ . \ f'J1l ' f
J @';IMofe 6/\Jl! -N. lNoIr.NJ€ S-
f( y. IJ-~
Ails
()
Please print name and address where record is to be sent.
~e QS au le~+
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
. ~o I ~) \ ~ ~
~ (t ~ vY: /' (,\11 Application to Town Clerk
~~:R:~:r~sS~:c~i~nDEPARTMENT OF HEALTH t t' \ for Col!)' of Marriage Record
",
........................................~...... .................... Jimllll.:llgIB.g..glllllg..llllgJ(..;o.,l,!j..../......<.....::........................,.......
. . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . .. ..... ....................
................,..................... ....................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . ....................
.................... . . . . . . . . . . . . . . . . . . . .
.. . .................
............:...:.;...;.;:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
..........................
.................................................................................................................................. .
Search and D Fee $10.00 Search and ~ Fee $1 0.00
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.
. ......,..................... .....
. .............................
...........................
... .............
. . . . . . . . . . . . . . . . . . . . . . . . .
..:.:::.::::::::::::.;:::..::.:::.:~i~JJ...Ii.:IDRe~EI?.'..lg"M::::III:::~'lllltlll::..
.... .......
..
....................................................................
.................................
......................... ..
. ........... .....
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 I
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) Abu (~ltM y
. ....
. . . . . . . ... . . . . . . . . . . . .
.........................
. . . . . . . . . . . . . . . . . . . . . . . . .
.........................
. . . . . . . . . . . . . . . . . . . . . . . . .
........................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..............................
. . . . . . . . . . .. .. .
Name (Firs~r. _. (Middle)
~fride AV\~ G-
Bride's Age J ~
or Date of 3 '8-1 "
Birth
Residence (County) r _
~fride Du -tCVle S' 5
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
~~
(State)
N\
For what purpose is information required?
-irrfo/ i (j ~ y SOc..-.;;eC. CO Vd
In what capacity are you acting?
What is your relationship to person whose record is requested?
If self, state "self."
~ I-p-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
VS-34M
Tracy L yn Scala
256 North Linden Street. North Massapequa. New York 11758
Home 516.541.6858 . Cell 347.242.4602
April 16,2004
Town ofWappingers
Town Clerk
20 Middlebush Road
Wappinger Falls, NY 12590
RE: MARRIAGE CERTIFICATE
Dear Town Clerk:
I am currently a candidate for the New York City Police Department and require an
original copy of my marriage certificate. My maiden name is Tracy Scala and my married name
was Tracy Scala-McCarthy. My date of marriage was November 24, 1994.
I was advised I could request this in writing and have enclosed a copy of my driver's
license as well as a check for $10.00. If you could please expedite this request I would greatly
appreciate it as I am meeting with my investigator on April 27, 2004 and she has requested I
have this information at that time.
You may send the certificate of marriage to my home address at 256 North Linden Street,
North Massapequa, New York 11758.
Thank you for your attention to this matter. If you need additional information please do
not hesitate to contact me at 347.242A602.
Sincerely,
~CUI,{;{ 1~ A~
Tracy L.QScala
o
~ \\ I
;~\~o\QI~
~
ST . ,c.
1117.\ (.
w.h~.i '
,:.1'
."'~;
Sandra
Town Clerk's Office
20 Middlebush Road
Wappingers Falls, NY 12590
Dear Sandra,
Enclosed please find a check for $10 for a certified copy of my marriage
license. As we discussed on the phone, please send it to my husband's
office in the enclosed FEDEX return envelope. The facts about the license
are as follows: "
Date of marriage: 3/18/83
License issued in Wappingers Falls
Husband's name: Michael Borden Rynowecer
Wife's maiden name: Nancy Beth Carls
I thank you very much for your help!
SinCerelY'~..
It ~
N';'~yn ecer
23 Riverbend Drive
Natick, MA 01760
508-651-3174
~\~O)~~f
~
\ , \)
Jun-15-04 09:05am From-NETHERWOOD ELEM>SCHOOL
8452292797
T-227 P,OOI/OOI F-652
/
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. , .,\~"t,
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g.~ 0.; :f. ~ ~
i;
. ,~... ~~"
~ ~q...'~ "
q~ '--
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for Co of Marria e Record
()....)......... .... ...:..IIBill.B:IIII:I.:lil~III.:..tll.il.:.lni).':..:I.
...................................
..........."......................
.............................. .
....................... ..
.................. .
~ee$10.00
Lk:J ~ercopy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marnage occurred.
~ Fee $10.00
liZ.I per copy
A Certified Transcript includes all of the items of information
occurnng on the original record of the marnage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
........... ..........
......................
. . . . . . . . . . . . . . . . . . . . . ,
......................
......................
............................................
......................
......................
......................
......................
......................
......................
..
.. ..
.................
.................
:...:1.1.:.1..:1111,1:.:11111111:.:.1111.:.:111.,.1.1111Iii 1::.:
..........................
...........................
. . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
.............................
..............................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. ................. .....
...................................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
................................
.....................
FEES: Make money order or check payable to New York State Department of Health. Please do not send cash or stamps.
There is no fee for a record to be used for eligibility determination for social welfare or veteran's benefits.
PLEASE PRINT OR TYPE
Name (First)
of :'\
Groom \1\
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
C0
(State)
/2
For what purpose is information required?
In what capacity are you acting?
L/ fV V\tU~ lW~ J:lrf f}
~ft nj e 1$ ;c-. \l <) J1. y. \ ;).~~ t,
DOH-301 (3/93)
(First)
(Middle)
(Last)
t3r~6
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
I ,
(p 3D/)Cf
(County)
tJ uc~ ss
(State)
IVtY',
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.
'7
Please print name a d address where record is to be sent.
~t ~ l '3(v~e
l/ N ~ S'ILr A.vt.. Apt A
u.A. ,t") cSo fo...\\S, /V-Y. /J.5Q6
(PLEASE SEE REVERSE SIDE)
VS-34M
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for Col!}' of Marriage Record
...................
.................
...... .... .......... . ............ ............. ...
.................... ......................................
..................... .....................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . , . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................... ....................................
..................... .................................
.................... .......................... .
............................................... ..
..................,...........................
......... ................................
. . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . .. .. ..
.:;;::!mllli.iIE!il'IIII:I:illl"II:I;;;:lltill.:;lli~:..!;
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.......................
r\il Fee $10.00
lLl-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.
..............................
............................
..................... ..
.................
......... ............... ............... .
.................................... .
.. .........................................................
.....................
...................
...................
...................
...................
.;.;:I:~:IIII..I;~IIIIII:;:.IIII;..lftl;:::I:III::.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 ~) . 0-*
Groom's Age
or Date of
Birth q. 1 . 10
Residence
of
Groom Z8<1 00... ~ Illd
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle) (Last)
(lCJd Aby;
5
~W~S
(County)
t-1Y
(State)
f2-=L
~. d-o.03
For what purpose is information required?
~~"Xg,ou~h S:: ff
In what capacity are you acting?
(First)
(Middle)
Ann
(Last)
Name
of
Bride
Bride's Age
or Date of
Birth ~. 1 '1.5
Residence
of
Bride
If Bride Previously
Married, State Name r:- .
Used at That Time Ie?' bu.rc l
Place Where
Marriage Was
Performed
,
~o.Cle
f\I'{
(State)
11C
(CQunty)
zs:;.OQI( W '.( &:L
\
What is your relationship to person whose record is requested?
If sel~rr "self."
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
5~l '04-
Please print name and address where record is to be sent.
(PLEASE SEE REVERSE SIDE)
VS-34M
NEWYORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe>' of Marriage Record
................. .
. . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.................................
................................
.............................
..... .....................
. - . . . . . . . . . . . . . . . . . . . . . . . . . . .
...........................
. . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .. .
.............................................................................................................................................................................
:::::.:::::::::.IMII,::,B:.IIIIII::!lil~III:.::tgllll.:Inl~:
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
.M Fee $10.00
~ per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
. . . . . . . . . . . . . . . . . . .. .. . . . . .. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . ............. .... .. . . . . . . . . . . . . . . .
:::::::,:,::...::.:::::::I~..E!:.gg:~~'*~m~::::~~~M:::!INI!qgMm:F:@@::,':!!.!:!.::::
............................ .
..........................
. ...................
. . . . . . . . . . . . . . . . . . . . .
............................................
....... ....................................
............................................
............................................
............................................
............................................
............................................
.. .. ... ..... .. ...... ..............
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 n J.. ~ -
Groom r a , (' J t k:.-. r I We.
Groom's Ag~~
or Date of3..?
Birth
Residence (County)
of D ..L J -
Groom cA. ,~?.s
Date of Marriage MI
or Period Covered '1'1'lfJ.., :z 7, :z..Pf 6)-7l:L1
by Search 't)
Place Where
License Was ())ot i)~ )
Issued ....r r
(Last)
II eo.. ve
(State)
JJ
For what purpose is information required?
r vte~do c"Py ~MY V'UM''/''<
In what capacity are you acting?
DOH-301 (3/93)
Name (First)
r" ~fride d evr"e..-r
Bride's Age
or Date of 37
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle)
(Last)
D/~e~~d,
(County)
DVl~'>
What is your relationship to person Whose record is requested?
If self, state "self." ~ / J-
If attorney: Name and relationship of your client to persons
Whose marriage record is required.
L./1r:L7/0'1
Please print name and address where record is to be sent.
-W /llfS
~1 OJ{
~t/
~ ID
VS-34M
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe>' of Marriage Record
........... .. :::::<:. :'::.:.::.:,:::::: ...ii.iimllliB'.'I:IIII.I:i.III~III:i.111191.i.llil:::.:.:::,:.:::::,:i.::.:::'::':::'.I:..
~ Fee $10.00
~ per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
................................................
. .. ....................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.............................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. .
.............................. ..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
............................ ..
. . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . .. .
Search and
Certification
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
....... .....
..........................................
...........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.. ....................
':::F:h1e:AIS:CaeUSTs'::pIBM{ANO'FUiMm'PEI
.. >>~UU\.)\.::::;....:.:;: .:::. ::.::..:::-.:.:.:~f-:::::~:::.;:::.:;....-::.:::.::::~~:-::~>-:.;.;t/:: :.;)\.}~:::::::.::<\:: :': :': j(...;...::-.::...:...::;'):j :,~:, .:....:.:;...;......~../..t~~...::<.:: ~.. :.:.::
.. ......... ...
. . . . . . . . . . . . . . . . . . .
...................
.................................... ...
........................................
.......................................
.................................... .
...............................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . .
.......................
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)
~room tn,,~ her ~
Groom's Age
~~ateof 06)~8 l6
Residence (County)
~room \JJ \-c.ne.~ ~
Date of Marriage
or Period Covered
by Search
Place Where
License Was--r ~ . \ ('_ { \ '\
Issued \ '-'~}-X, D" \)...J
(Last)
Sosn
(First)
(Middle)
(State)
(State)
For what purpose is information required?
O~;f~\~~
What is your relationship to person whose record is requested?
If self, state "self." 25~
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
o
Please print na e an address where record is to be sent.
J Lo fe0CoC-t-- Ulne..
IO~ htcefG i ~ I (IJ 'f I;;; &d
~~;3~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' of Marriage Record
:::::::::::i:::i:::~:::::::!:!:::::!:::::::::::!:!:::!:::I:i:::::::::!:::::::::::::::::::i:::::::::::::::::::i:::::::::i:::::::::i:i:::::::::!:::1::::::::::m1:l11::i8:::IIIIII::118,1_1::::IIIII.:::IIII:::i:::::::::::I:::::::::::::::::i:i:::::i:::::::::::::i:i:i:i:i:::i:i:::::::i:::::::::i:::::::::::::i:::::::i::~::i:i:::::::::::::::::I:::::::i:i:::::::i::
Search and ~ Fee $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.
::::::::::::::::::~::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::~:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::IU:.R:::lllelill.:::IIII::::.I:::IIII:::.;.:::::::::::::~::::::::::::::::::::::::::::;,:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (First) (Middle) (Last)
of f<, L'r )-- ~V(;... ~ e S~lo\ I~ Lp", t7 of Chr~ ~ r !i'f ~ Cf-J
Groom Bride S ~ C ........f/'
Groom's Age I "J Bride's Age I /6
or Date of I I 7 11 3 or Date of '7 d t.
Birth Birth
Residence (County) (State) Residence (County) (State)
of ).J h \.; H tJy of (1 fd.~.I.r tV v
Groom I Bride I
Date of Marriage If Bride Previously
or Period Covered ? I :;/0 D Married, State Name
by Search Used at That Time
Place Where ~ Place Where 5' 1 (j 1./ 1,., ( ~ l-hr /) f ~
Ucense Was ,....; ~/f'-JQP Marriage Was {
'Iii c Ir~l/ ,........ ./r( 1M
v--' ...... i
Issued Performed
For what purpose is information required? What is your relationship to person whose record is requested?
\~ C r . Fe If self, state "self.. ,se-I P.
( .I ,
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 If /;6~
.1.1 f /p~J-~ '1
Ui,J~
Address of Applicant'/ Please print name and address where ;ro ;J~~~
31 A-('k( II L~e
W fo Vj~t fJ v- I 2 S ? 0
./c:.tj I
I ~ \
W Ii
DOH-301 (3/93) \" , 0"1 0
J
(PLEASE SEE REVERSE SIDE)
.~\\)\ Q /
~ _. \\J
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
:i:i:::i:i:::i:i:::i:::::::::::::::::::::::::::::::::::::::::i::~::::::::i:i:i:::l:jl:i:i:::i:i:i:i:i::::::::::::::~::~::::::::::::::::::::~::i:::::::i:i:j_lllB:::11111.1:::IIIIII::ill_l:i:IRI:j:::i:::::::::::::::::~::~::::::::::j:i:::::::::::~:::i:::::::::::::j:~:::::::::i:::::j:i:i:j:~:~:::i:i:~~i:::~~i~:::::~~:i~:::~:::::::::~::i::::::~::i:::i
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 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_I:::_Bm.fit~1111::::11.::::8,111:::&11::::::::::::::::::::::::::::::::::::::::::j:::::::~::::~:::::::~:::::::::::::::::::::~::::~::::::::::::~:j:::::::::::::::::::::::::::::::::::::::::~
PLEASE PRINT OR TYPE
Name (First)
~room {}//~e IY
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was I I I
Issued lA-/a
(Middle) (Last)
/1// //I~'J1 S
&-/&-S?r
(State)
/~
{ ~ /50- C/7
(County)
IV
C:-{ s. A, I
Name (First) (Middle) (Last) ~
~fride S' a h clv'1 b'1'7iC.Do/vJe'tfl\'fJo..(I
Bride's Age
or Date of / . -;;:..
Birth d - U? -{p 7
~fesidence ?
Bride . 0 (,(
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(State)
../l/
j JLUV\
.It...d
For what purpose is information required? What is your relationship to person whose record is requested?
'\. ~ Y\l\ ...ti.., I) VI If self, state "self." 0.. ,. p
1Jf' V~)ro r ( e ~ l! \(... ,,,e y t V\ /.-c;( LV J I (:9'!11 J e -r-
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Sign ture of Applicant .
RA/It\.C~'-1 Wt~u
Address of Applicant
I S- C:e;f' ro II ~S:j ~
fb..l..{b'v) Ie -e--e/-;f, e ,(..- V t ~(PO 1
DOH-301 (3/93)
Date
I.t It- 1(; L/
Please pr nt name and address where record is to be sent.
,S Cat'f"cl ( ~
{b i..{ Ii' K.:e -e f 5" J C I 1\...1 Y I J. (p 0 j
"
t;~
/ \O~
~ . .Jr.\\~ tel
~ ~\\) ,
(PLEASE SEE REVERSE SIDE)
NEWYORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe>' of Marriage Record
.................
.................
.................
.................
.................
.................
.................
.................
.................
.................
.................
..............................'.........'........................
;.:.;.:.;.:.:.:::;::::::::::;:::::::;:::::::::;:::;:::::;:;:;:;:;
..
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . .
. .. ............................................
.. .................................
.. ........................,......
. . . . . . . . . . . . . . . . , . . . . .
.................
.........................
.........................
.........................
. . . . . . . . . . . . . . . . . . . . . . . . .
.....................................................................................................................................
.....................................................................................................................................
.;.,.;.;.,.,.,.;.;........;.8.....S.....;.;.0;.....:p.....:.:s.....s.....s......:O.....:s.....II.....:.:.m.....:e....s.....I..R.....S....D.....:.;.;~..G.....,....:.:.:.:.:.:.:.,.:.k...:.:.:.........:.:.;.:.:.;.;.)...;
.......... .. .... ,.. , "... .. ".. ...
........... . .... . ...... ... .. . ....... ........ . ... ..
.............. ..... .. . ...... .,.... .. ...... ....
.......... ... ..... ..... ." . ...... ... .. .
................ . ..... .. ...... ...... ..... .. ...... .
:}}}}}:.::}:.:::::/\.:.:.}\:.:.:::::.:::{::.}:.:::.:.>:::::.;::::::.:::::.}:.:::.:.:::::\.:.:.:::::.:.:.:::::.:::::.:;:.::;.:::.:.:.:.:.:.:.:{:::;:::::.:::::.:::.:::::.::>:::::.;;,.:::=::,.::.::::.....:
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
m Fee $10.00
~ per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings. or settlement of an estate.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
...........................................
..........................................
...........................................
..........................................
...........................................
..........................................
...........................................
..........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.....................................
.......................~........ .
........................ .
. . . . . . . . . . . . . . . . . . . . .
.................
...I:~.II::::glllllill.::IIII::::IIII:III.lil....
...................................................
..................................................
............................................ ..
.........................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
...................................
................................
...........................
........................
........................................
. . . . . . . . . . . . . . . . .
... ................
....................
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
..................
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 ~/L.h~;c../
Groom's Age
or Date of
Birth 7 - 2.. '-t" -
Residence (County)
of ~ .--;-
Groom (/tA- / ~ ")
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Middle)
(Last)
~..r~~_
s
/9 ~ /
(State)
py
./'7 ;--.5'-
#OV
r
For what purpose is information required?
"v Y 57.... r~
~ S;''''~/'''I'''
O,c... '" L ,<.. L....... ~--' s. -c......
,.....--.-
JoQAC "-h........ /';7
In what capacity are you acting?
.s- alP
Name (First) (Middle) (Last)
of ~
Bride J Oe..~de..... ~ ~~...c. N.6o<- ~ ~
Bride's Age
or Date of
Birth ' <:> - /,} - I" '1 , ~
Residence (County) (State)
of ~
Bride /.J '-- 7c;.. L.., 5 "J e Y
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
What is your relationship to person whose record is requested?
If self, state "s~~ l t=
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Address of Applicant
2" ~~_7i!-
1/,,"/1 h/~
"t( _ s:-;- /"-?'/';J ;e oL..
"JY. .
I "Z- S" <; .,.,
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
:.i:1..:'.'imleli....::I,IIII:g:.:IIIJ,lli.:llflll,:II'l ............................................ ;';.iii:.:?
... .. .............................................................
. . . . . . . . . . . . . . . .............................................................
..............................
. ....... ................... ..............................
. . . . . . . . . . . . . . . .............................................................
........................................................... ...............'.............................................
............... .. ................'.................................. .............................................................
...................... ..............................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Search and Q 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.
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
...................
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
...................
...................
. . . . . . . . . . . . . . . . . . .
..
.......... .....
.................
.................
..
.................................
.................................
.. .....I1.i.illllll:::lllellll.:.;IIII:::III.;I,III..111
;.;.;.:.:.:.:.;.:.;.:.:.:.:.:.:.:.:.:.:.:.:.;.:.:.:.:.:.:.:.:.:.:.;.:
..................................
...................................
.....................................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
...................................
.....................................................................
..................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
......................
. . . . . . . . - . . . . . . . . . . . . . .
......................
. . . . . . . . - . . . . . . . . . . . . .
......................
.......................
......................
. . . . . . . . . . . . . . . . . . . . . . .
......................
....................
.................
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)
W, \\iO-
-s
(Last)
Hit
~.ClI.C-L.L
Vl'\.
uy.
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)
(Last)
q-O'6' 5<6
(County)
'Du-t<ll-u S"":::>
(State)
'l -, 8 -~ I
(County)
(State)
~ \
"t,ut(1lus
5-'7-?Cj
For what purpose is information required?
Q..",<'""",,,
What is your relationship to person whose record is requested?
If self, state "self."
In what capacity are you acting?
~,\\
0-
..k\" .
If attorney: Name and relationship of your client to persons
whose marriage record is required.
3 J~ 5 Jf) .
Please print name and address where record is to be sent.
Ny 1115'-:;.o
Plv
DOH-301 (3/93)
VS-34M
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town Clerk
for COe>' of Marria~e Record
............ ......
. . . . . . . . . . . . . . . . . . . .
...................
....................
...................
..................
....,..............
................"
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
...................
..................
. . . . . . . . . . . . . . . , . . .
..................
...................
...............................
. . . . . . . . . . . . . . . . .
.................
. . . . . . . . . . . . . . .
,lillegi.i:B'i:ig:gilg'g:"gll,lgg':':lllisl:.:lnll
.... .... ,.....
....................
. . . . . . . . . . . . . . . . . . .
.................
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
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
....................................,.
. . . . , . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . ,
. . . . . . . . . . . . . . . . . , , ,
. . . . . , . . . . . . . . . . . . .
:.b'e:i~E:.:::tfM~.:ift.}E.:)ijE:}:E~B::.::M...{:;::k:iil6:a:E'M"':i+':ee::e}} .....
~Jir>:.;.;::.;.;.;::.;;;::.~f.t;.)~:!MY~mr~]i;.:.;.)~{.;.;.?~:f]~!~t.\:::.;::.::)~;n~JM:;:;!lfi:.;::.:.;J]r:~E\.;.;.;S:?~:;
... ............ ..... ..... ...... .....
............................................
...............................,........................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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)
~froom ~c)k t- A
Groom's Age I;).. - ;).. ~ - 51
or Date of ..L I
Birth tt:rC,.f\-e.S
Residence (County)
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Last)
C. r~~'
j~-d- 4-qtj
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 k of tJ~ c p.
Performed 'J OWn... ,
(First)
M /LV- e...
jD-/3-S-"
u-~eJ
(County)
(Middle)
(Last)
c.. \0-\ ~
IV.
(Stat )
fYl~rj
Ba..Ic-e.r
For what purpose is information required?
In what capacity are you acting?
What is your relationship to person whose record is requested?
If self, state "self."
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
Date
3 -c2S- -0 If
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
..............................................................
........................................................................'.................................................
.............................................................
...............................................................
. ........................................... '.' ... . . . ... . . . . .
.............................................. ...............
.............................................................
...............................................................
. .. ......................... .. ................ . . . . . . . . . .
;:;m.:';.:.:.:.::;';.:.;':.::::';.::;:;:;::';.::;::';.:.::;:;.:.:';.:::.;':.::;:'.'.::;:'.'.'.':;.:';.:.'::.'.:::';';::,.:.;:;::.:.;.;:,.:.:::::.,::.;.:.;::.;.,:;.;.:.:,;:::;:;.;.:.:.:.'::.::;"'::::::;:':":::';:":::::::';.'.::::::":"::":;'::":':::::::::::::::::'::::::::::::"'::::::::::::::,:,'::,:::,'::::::::".,.:........
.... .!VftE...^:e....B.E.~AB.":..;riiE..SIm:E.:r'ii...I."""kii!i:~l>i:...^n......:i;iIi;;\"............;.................;.;..;..
mii~;:;~triR~:::.;.;~im8E~iL::~;:.:~;.:.;.:;8*t:;~::.;ieme;:.;.~.;~:::.:::i:.;9:.:.;.l~~~i~(W~~~~~~:~~i!~*;.:~;;;Fii!i~~!~~iiii~i~i~~~~~~;:;~:;::::::::::::::.:.;...... . .
. ... ..... .... ..... ...... ..... ..............
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . -
..............................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
..... .... ..................................................
Search and ~
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record Issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
....................
....................
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
.....................
. . . . . . . . . . . . . . . . . . . .
.....................
. . . . . . . . . . . . . . . . . . . .
.....................
...
Search and
Certified Copy
D Fee$10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
.........................
.........................
. . . . . . . . . . . . . . . . . . . . . . . . .
.........................
. . . . . . . . . . . . . . . . . . . . . . . . .
. , . . . . . . . . .. . . . . . . . , . . . . .
::IC.e.:.I!iil.Rllml:PIII::I.~!..'1:!pm.fji.
..........................................,,,...........
.......................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
.............................,................~.....
.............................................. ..
..............................................,.
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
............".............................
............... ............. .....
.................................
............. ............,.....
.....................................................
. . . . . . . . . . . . . . . . . . . . . . . . . . .
..........................
. . . . . . . . . . . . . . . . . . . . . . . . . . .
..........................
.......................
....................
...................
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 (Firs~
of
Groom
Groom's Age /)
or Date of \ ' 'l1r 1 '(
Birth J /
Residence ~(county)
of .
Groom
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(State)
\"6 v(( ./ fC[
In what capacity are you acting?
Name
of
Bride
Bride's Age
or Date of
. Birth
Residence
of
Bride
If Bride Previously .
Married, State Name W..e '" \ - r-P
Used at That Time l ~ \ \...
Place Where
Marriage Was
Performed
(State)
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
Please print name and address where record is to be sent.
(PLEASE SEE REVERSE SIDE)
VS-34M
Application to Town/City Clerk
for COe>' of Marriage Record
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Search and 0
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
r71 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 (First) (Middle) (Last)
of ~eJ . i q C\.j of So CJ cl~c.~(J
Groom 1'>( 0 Bride Y) I c.-..
Groom's Age LjJ Bride's Age J
or Date of , 2 '3 I or Date of Co - 24 - I S
- -
Birth Birth
Residence bcounty) (State) Residence (County) (State)
of \ 0t-r ~p N 'I of \) v t-<-~e.s c. N y
Groom S S Bride
Date of Marriage If Bride Previously
or Period Covered 0 c-\-- \ Lf 2...00 CJ Married, State Name
by Search , I Used at That Time
Place Where Place Where ~ ot h k l l
Ucense Was \J'\-, pp Marriage Was ~ u..) Y"\ S'~ (
Issued I h , -e. r .$ Performed
For what purpose is information required? What is your relationship to person whose record is requested?
P'1 1- If self, state "self.. SR\~
5S ~o r
In what capaci~e you acting? If attorney: Name and relationship of your client to persons
whose marriage record is required.
If
Si9";) of Applicant DnL~ Date fl10t
~ "I ., I"ch I 0 I 20 C) L(
n .....,
Address of Applicant ...., Please print name and address where record IS to be sent.
:J. 5 r<o b I "l LY')
Wc~ P ~ { r s f\J y I 2.S CJ 0
P .
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Col!}' of Marriage Record
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.
::::::::::::::::::::::!::~:!:::::::::!:!!::!:::::::::::::::::::::::::::::::::::::::::!::::::::::::::::::::::::::::::::::::::::::::::::::!::::::::::I.:BI:::IBIJIlB1~:~.II::::III:::I:.II:::I.i::::::::::::::::::~:::::::::::::::~:::::::::::::::::::::::::::::::::::::::::!:!::::::::::::::::::::::::::::~::::!::::::::::::::::::::::::!:::::::::::
PLEASE PRINT OR TYPE
Name (First)
of 7
Groom
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
by Search
Place Where M
License Was/"
Issued
(Middle)
?
(Last)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of !
Bride ~
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was ~/ fUj)( g
Performed
(First)
(Middle)
~8
1f
(County)
(State)
<.
(State)
~
IV
~
For what purpose is information required?
~/YA.p~
What is your relationship to person whose record is requested?
If self, state "self." ~~
In what capacity are you acting?,
~ C -lJj '~ .1Jo
o '
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date
d/~/{)Y-
57 1 /Ct.,J..-1 ~/ .
~JJ_/.)ft/~--(:J J 6 U 0--- -'/1 J 0 tY 0 0; Y
Please print name and address where record is to be sent.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
Application to Town/City Clerk
for COe)' of Marriage Record
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Search and 0
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee$10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle)
of
Groom
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)
(State)
F~.~ ~~t.p~~p~~~.is i~f~~~.~ti~~ ~~quired? What is your relationship to person whose record is requested?
If self, state "self." '::5e \ f-
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date
?
Please print name and address where record is to be sent.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
TOWN OF WAPPINGER
TOWN CLERK
GLORIA J. MORSE
SUPERVISOR
JOSEPH RUGGIERO
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590-0324
(845) 297-5771
TOWN COUNCIL
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
ROBERT L. VALDATI
January 30,2004
Ms. Barbara Coleman
PO Box 514
No. Hampton, NH 03862
Dear Ms. Coleman:
In reference to your request for a copy of your marriage license, we have checked our
records from 6/1962 thru 3/1967 and have found NO RECORD in this office.
Your marriage record will be on file in the office in which you originally applied for your
license. Did you apply in City of Poughkeepsie or one ofthe townships around this area?
Your other option is to write directly to Albany, New York; however, it will take many
weeks to get a reply from Albany. Also, they charge much more for a copy than the
towns.
Since no record was found, I am returning your check # 3317 in the amount of$1O.00.
Sorry we could not be of help in locating your marriage license.
Sincerely,
Sandra Kosakowski
Deputy Town Clerk
331
54-153/1
4
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New Hampshire . n
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I
TOWN OF WAPPINGER
TOWN CLERK
GLORIA J. MORSE
SUPERVISOR
JOSEPH RUGGIERO
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590-0324
(845) 297-5771
TOWN COUNCIL
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
ROBERT L. VALDATI
January 27,2004
Barbara Coleman
PO Box 514
No. Hampton, NH 03862
Dear Ms. Coleman:
I received your note requesting a copy of your marriage license and have been trying to
contact you by telephone (603) 292-1527 all day with no success. Ijust get a "speedy
beep, beep, beep".
You did not give me the date of your marriage. Please forward the date of your marriage
so that I may find it in the correct marriage record book. Our books are filed by years
and we would have to go through each and every book for every year to try to find you.
Also, we would only have your marriage record here if this is where you originally
applied for the marriage license.
Either send me another letter with the date of your marriage or you may call us at:
845) 297-5771
Sincerely, ,/
I o/:~ .._~L'
I:)d /-..,<-- j.-.i.~ I' \ ,-..-.-
Sandra Kosakowski
Deputy Town Clerk
Town of Wappinger
~
j.
I
.-
Nb . JrlK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
..
i.rnIR~Q.ft.B!IIB'f1lllflg!g.!~g~i9jiIP~)<
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 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,,,""""""::::::::,,,...,.,.,,,,,,,,.....,,,,.,,,>.,.,,..,..""""...'.""...."'..""..',"..'."..">.s.""". ...,......."",......",....""',..,...."...""",,,"".,"'"....,""',.,...."..,.,,',...>.'rr.......,..'::::..,.,.".,...."., "",} """,::::""::::::::"""."""",,,', ......
....................................... .................... ...................ril"'E..'Jli"SE....,...'~Mftl"" .."i"'s..eAftM"'A'Nr\;"~S'M" ..rE' r...... .
.,......:::::::-:::::.:::::::::::::;::::::;:;:;::~:;;iii:!ii!:!:!i?iiiYii)i;:;i;!::;:;:;:::;:::?rTIL9L:.)Mf:::;:;::::.;.;.)i*~ft:::::::i!mE:.:.;)J!L.:.:\in~g::;::::::.}t1:;::::.::Pi;iirt::;.;i:.;:::::.:UL.!:::iJI.::::::SHU:;:;);::::::::::::-:-:....
PLEASE PRINT OR TYPE
Name (First) (Middle)
of
Groom ~e.\L. A,~,.0
Groom's Age
or Date of
Birth C( I I
Residence (County)
of
Groom \
Date of Marriage
or Period Covered
by Search
Place Where
License Was
Issued
(Last)
n,~J
Name (First)
of \
Bride f. 1\\
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)
~!~V~b
(Last)
t;, ;Vt f)('''':..ll
,N'
-71-
(State)
~- ~
(Stat~)
; ': 1'-. .
(J
~ \L ,'<l.
~ \~.
C~)..t.:..;..
k_).C V I Ile /
For what purpose is information required?
~,\~ r~ n.voqL UJ "\-\ {oo-11 ~ <-vrt",{
What is your relationship to person whose record is requested?
If self, state "self."
In what capacity are you acting?
~.--. 'l} l' l~ ~..-\l
If attorney: Name and relationship of your client to persons
whose marriage record is required.
~.
~
,
