2011
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
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 setllement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of
Gr
Groom's Age
~:;'ate of I ) I ()() I ~ /
Residence (County)
of ~ I .
Groom J.J1A.-rC h<s
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was I '\ J
Issued VLJ T
(Last)
10 Uf).e
(FIrSt)
Bride () ;~
Bride's Age } )
:~of 05 dO) I}
Residence (County)
:ride 1Ghe~
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was. 'S+ Co / LA 1/"/
Performed t>
sk{
(State)
AJY
(State)
f\)
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.
} d ~6 }J
P print name and add~~e
u u '-=:J~ lb U ~ ~1!dJ
ord is to be sent
DOH-301 (3/93)
I
(P~~~'.~RS~..~IDE)
TOWN OF WAPPINGER
TOWN CLERK
.~"",j
,
IOY'
\..,
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
(Middle)
P-
(Last)
CqrrC12,lo
~1
(County)
.Dvtc~
at; 06 09
(State)
0'1
lm'~Iu\ion ?CI,"Q\S
In what capacity are you acting?
(FIrSt)
't1C\i/G\
(Middle)
-It
(Last)
('C,,'~2.L 0
Name
of
Bride
Bride's Age
or Date of ~ 3
Birth J
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(State)
(County)
DJtC~6 0,-/
CH:c., Cur rr;:Io,
What is your relationship to .person whose record is requested?
If self, stale "self..
')e\i .
If attorney: Name and relationship of your client to persons
whose maniage record is required.
Signature of Applicant
~Q~1\'~L'-0
Address of Applicant l
~ t-f(~l\ r '
vJ~ M 12 '=:>-<1 V
DOH-301 (3/93)
1)\\'3 \\
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
'"
:~~~~,l..
DRIVER LICENSE
10: 179332107 CLASS 0
1--(1 c.-
~-~ --- ---
. CARRAZCO
IiJARIA,ANTQNIETA _.
5,\4AXWELL "'" . I
MPINGER_ FUJNY 12590
008: 09-27".6
SEX F EYES tR HT: s-oo
E NONE '"
R. NONE "
ISSUED 09-17-10 EXPIRES 09-27-12
.
ORBAN
DONOR
L~MK~H::J
-:tP 'I y
~ / 0/07
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
Search and ') (''1'1' ,f' \ ~ Fee $10.00
Certified Copy c:x.. ~ 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.
(Middle)
(Last)
N
.------
rtf);-
(State)
~
5/l-~1/vv{ (012?G* /o;f.
In what capacity are you acting?
Name (Middle)
of
Bride
Bride's Age
or Date of
Birth
Residence (County)
:ride 1){A.3c){ rc-' 5
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
, ---
L( /Je 2--
(State)
~(
What is your relationship to ,person whose record is requested?
If self, state -self.-
WIre
If attorney: Name and relationship of your client to persons
whose marriage record is required.
II ( ( I Z-tJ / /
Please print name and address ~e record is to be sent.
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C)' r:- }Jc?(Y( b (tol<- e. c_ (/2-C Ie
IZ57c/ '^fA 'IV (5 -e-M I f7 r{ . /,1 ~c;o
DOH-301 (3/93)
(PLEASE SeE REVERse SIDE)
If'
~~
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~
-,-.
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
,'1\;..,
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certified Copy
r\7I Fee $10.00
l.,6J 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 es: passports. veteran's benefits, court
proceedings, or settlement of an estate.
Name
of
~~\ Bride
Bride's Age
or Date of
Birth
(County) (State) Residence
J\ \n' (' D,-\\Ic \\ 0,,) \)\,'S~~;~ of
y H'\ . .~., Bride
If Bride Previously
Married. State Name
Used at That Time
Place Where
Marriage Was
Performed
.,
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence
~room (j A
Date of Marriage
or Period Covered
b Search
Place Where
.-
Ucense Was
Issued
o~
(Middle)
(Last)
" ~.
S~f) \er<\ber- :}~, \ qq 0
VV6~~'00~
For what purpose is information required?
\'e(""SO()~\ {\ eL()r-~
~ ~s,\- 0 \~ \ ,(~.se
In what capacity are you acting?
','
Signatur~.AppIican. t n
l.J /\"-f<'rOY~
Address of Applicant
-rei \tIes+- Grt:~-t\ Kd
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DOH-301 (3/93)
(Middle) (Last)
r Or\ p
(First)
fulo.e-b
('(\rx"l
(County)
\I.u~-'r ~\!"\
U- N ll~
'~\s5
\~ \
What is your relationship to person whose record is requested?
If self. state -self.- '
r' 'J'
.:::.e
If attorney: Name and relationship of your client to persons
whose marriage record is required.
d (0 l dU \ \
Please print name and address ~re record. is to be sent.
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., q We -; t Co r-1r:J e'-\-\- ~cx-d
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(PLEASE SEE REVERSE SIDE)
"
9- (} 5 - '1 u
=H 1t':J.-
January 5, 2011
Town Of Wappingers Town Hall
Attn: Town Clerk Marriage License
20 Middlebush Road
Wappingers Falls, NY 12590
To Whom It May Concern:
Angela Marie Patruno
79 West Corbett Rd
Montgomery, NY 12549
(845) 457-8103
I Angela Marie Patruno, previously Angela Marie Rios is hereby requesting a copy of my former marriage
certificate to Robert Todd Lisiewski. Enclosed is the proper identification along with this notarized
request. Please send the marriage license to the above address.
Sincerely,
Q,\~
')'Y). ~\..~
Angela M. Patruno
'S,...JC'>" VI \~...- "'-"- "'........
~~ ~("\h
NOTARY PUBLIC
COUNTY OF ORANGE
STATE OF NEW YORK
REGISTRATION NO. 02PA5065316
COMMISSION liXPIREs 3/20/ 20JL
.
N~~~~K STATE
.,_YINofee;_~
.~ ,,~
DRIVER LICENSE
10: 457 470 743 CLASS"
PATRUNO
ANGELA,M
79 WEST CORBETT RD
MOItlTGOMERY NY 12549
DOB: 05-19-71
SEX: F EYES: SR HT: 5-03
NONE
B
ISSUED: 07-07-09
FN2CJYCX04
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
r-l/Fee $10.00
~ per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or set1lement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle)
~room E ~ l Vv JAC\
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
~= Was Lv (L
(last)
rJ -t CIty I r "\A.
(Slate)
S121/0ll
_ ' +(;Vv\.
eiY s Fz,cQ.( ,S d Ot"-'
(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
(Middle)
L_
(State)
II Ii
t,..
For what purpose is information required?
MA~iol(;i~ ~\tLt..tJ.... (j\f1'J \ I-{j)QR;y
P Cy VvV \(L~, r l V\~' uJ) f1 to J
In what capacity are you acting?
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.
Address
l-7 I 0 SC'ld~ RDCcvt. 1-+7
F C/~ ~L,k.up S '( f (fJ;1 I 2h D I
DOH-301 (3/93)
Date
/2!2C) ID
Please print name and address where record is to be sent
s~Y\'UL-
(PLEASE SEE REVERSE SIDE)
~
,
t'
"
'"
r.'EWYORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marria~e Record
_1~~i;~iti;0;jli:~::;'::;i:;::::1t~~~~~<~y< ;~.:,:.:,<'<:..:.. '. '., .:',~~/ .Z,:~x::'.~',:'::L~'~1;J't~f:~;;~<$5fli.I.II_
Search and D Fee $10.00
Certification
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Depar1ment, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
~ee$10.oo
t{] ~rcopy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
.~'i[1rii:::LtV;dY~t.;:.::;r<:;:::~::~::~;,::;~;:;~ q '~~:. ..:. . ;~ ,.~. ;'., .::.:, '..:~<:~~~:::::i::...<~:~".::;..<:(:.>::::s:{r~ll.!I~ntlll..
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last)
~room 0OhY\
Groom's Age
~~ate of ;) 1 gl'~ /70
Residence (County) (State)
of
Groom
Date of Marriage \ \
or Period Covered \ \ d (Q 05"'
b Search
~:e~ll \{\ w"1n( e;s) Us I ;J{
Issued \A.A.'\r
19500
DOH-301 (3/93)
t
(Last)
NCO/2 ya. ~
Name.
of
Bride
~r::~ 5\ ~ 179
Birth
Resi (County)
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where <..' \
Marriage Was 0\'
Performed
(State)
L(
'Mlat is your relationship to person whose record is requested?
If self, state "seIf.- Y \ f
If attorney: Name and relationship of your client to persons
whose marriage record is required.
(PLEASE SEE REVERSE SIDE)
~
1/ I d ~ /0 S-
CLASS OM
I
I.oAftA,J
..... . iT'" . ~
NGeftl'fl-Si,NY 12580
~~:~
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'R)NQNE '11.
IS$Uftl: 11-14-06 EXPIRES 05-04-13
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78542651
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
(Last)
;(/(-1. 5 Q,
(State)
I{. L,
~. ?l) [:L 'fl (\ 4 (( h 1/5
For what purpose is informati$ln required? -
j) tA. 55 jJe) (,1- / V Ci 111 e {Iu~ rttjt f;'
, I/} ~
f<~newc~ '
In what capacity are you acting?
Application to Town/City Clerk
for Co of Marria e Record
Search and ~
Certified Copy ! ' Fee $10.00
, I 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 intormation may be
required such as: passports. veteran's benefits, court
proceedings. or setllement of an estate.
(Middle)
----
l
Name (FIrSt)
~ride 'frn- /0 t1
Bride's Age
~~ateof J 7 &l-I
Residence, (County)
of ) J '
Bride f.' fc-l-e 5. s
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Sla. Ie? I
;.1',
V\IhaI is your relationship to pe,rpo n whose record is requested?
If self. state -self,- 5e (,j.-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
L-
~'
Address of Applicant -, - ' 1 6
:3 (1"'rYl h,uk- (I rc./e Ij -
tJ :''-fj? I /17 ( f ;:., / is, IV { (~~'f()
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
r
.'
~
--0
6'
~
VI
-
D
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Depar1ment, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
O Fee $10.00
per copy
A Certified Transcript includeS all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or setllement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last)
~room VAt\) t\) i~ fAoCkL l)oJCt{ I4NT
~~e:;so~ge 04 / ~ 0/ (q '( (
Resid~') (County) (Stat~) I J
~room J;~~~ New rO(IA
Date of Marriage
or Period Covered Oq /0<1!2fl [ 0
b Search I '
Place Where '0 ' L'/l, } ~ J I \ J
UcenseWas \}JAf{ I ^-JueRS 'P7c.-c,.) IV'
Issued
(FIrSt)
(Middle)
(Last)
K~ L L V
Name
:ride fLIZf+g~1H c
Bride's Age .
:~teof 091Zb/fQ81
Residence I'} J (County) (State)
:ride J;~ {\JW YDvb(
If Bride PrevioUSly
Married, State Name
Used at That Time
~::~ W~pp [tJ6QZ5 {lftL J f (\j Y
For what purpose is information required?
I r7r1/bfLIIT(oAJ
In what capacity are you acting?
Gt2.oo/7
_..~,.".....,..- .-<.-
Address of Applicant
(I uJH (T€. G/l-TE- D(2/JJe
lJJ/rfP//lJ66rt.5.fIfLLI, NY, [2 r~ 0
DOH-301 (3/93)
What is your relationship to person whose record is requested?
If self, state "seIf.- ~ 'F. L .f"
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Of /2'6 /26( I
Please print name and address where record is to be senl
(PLEASE SEE REVERSE SIDE)
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee$10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride ancI
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage ancI certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or setUement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle)
of /. ()
Groom /1 tf)(/ if
Groom's Age y / 1('2-
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
b Search
~=: ;; ~NV 0 j; tf/II// i/I c;l.;
Issued
(Last)
lJ ///It-
r (County)
~JM,fvAc.ff
(SiY '1
Name (Fnt)
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)
~ ,AJ /~ 11ff'
(County)
p./ 1v4:-.1 f
(State)
W1
1(/(''''
~~/"" 0/:= ~///I'~c,ef
For what purpose is information required?
-;;- /--7/ r .5~c )tT'-
In what capacity arffi;~ pPj"
What is your relationship to person whose record is requested?
If self, state "self: 9-1 ~
If attorney: Name and relationship of your client to persons
whose marriage record is required.
I ~. 4//t.
Address of Applicant ~,.r;.J /I/-?/j
;/ Jf /;l j/ If /Ir ,1/1
1,1.J~~#
DOH-301 (3/93)
Please print name and address where record is to be senL
I/{,/( v/"
(PLEASE SEE REVERSE SIDE)
v
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee$10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
~$10.00
L..Jd 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 sett1ement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle)
~room I\J I ch () \ as -.J 0 ~ V\
Groom's Age
~:,eof d- d ~ ~d-
Residence (County) (State)
~room D-\'~- \1Ji ! s S
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Last)
U. CC\
For what purpose is information required?
rc<SS~Oc
In what capacity are you acting?
(Fot) ._
{ ~1 'S 'S ~
(Middle)
(Last)
C,- \et :\LlCC'\
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
tLCf
(.f ({J
(State)
~
to
(County)
U --t-tJ;\1 c:~ S
What is your relationship to person whose record is requested?
If self, state -self.- .
se[ f
If attorney: Name and relationship of your client to persons
whoSe marriage record is required.
Address of Applicant
'I 1-----0-( \2 Lt V)
WcA?r-v~15{ (S
\-Ct (t 5 (~
I -;)-. C)c;j 0 '
DOH-301 (3/93)
Please print name and address where record is to be sent
I
(PLEASE SEE REVERSE SIDE)
('
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-c.
'1P'~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Search and D Fee $10.00
Certification
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of \ .
Groom ,,;O~Q.. V\.
Groom's Age
;~ateof /~ /9 J '. 7)
Residence (County) (State)
of 5 tv t-\.1:.k G- ~-te. '\)ll A J ,
Groom IV'
Date of Marriage
or Period Covered
b Search
Place V\lhere
Ucense Was
Issued
(Middle)
(Last)
~ (V'C 'v, ~ \<
F...
For what purpose is information required?
Ie, s f
In what capacity are you acting?
~\~
DOH-301 (3/93)
(First)
N~ ~<-~
(Middle)
(Last)
Name
of
Bride
Bride's Age
or Date of
Birth 0
Residence (County)
:ride ~ w \4 'I ~ l<: . p-t ~ ~ R.-
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
.\.~ ~
(State)
IV'-
o
lient to persons
Date
'3 /'
Please print name and address where record is to be sent
'J wH-:rl<L.~~~ ~
t.v~1 f ;P,Q\:;) \1\ ,\~ /v'1 JJf'fO
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Col!)' of Marriage Record
~f~J.i'l:;~i_l&tj&:,;::>' .:.'. ...'.:,:~)i:: '" :.. .... . " ." '.. :,. .;:'.:,;::\t.:..~:~;.~:z~Y<':~~~~k0~~~
Search and D
Certification Fee $10.00
per copy
A Certification. an abslract from the marriage record issued
under the seal of the Health Depar1ment. includes the rv:mes 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.
rl Fee $10.00
lYJpercopy
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
raentage and certain other detailed information may be
required such as: passports, vetera"l'S benefits, court
proceedings, or settlement of an estate.
1:.~~::::iJk;-;~8:/><': :~.' , ' . ,. \ .;~t'~~~1F.,:,:;~ ."~::\;~:5if~:_w'
PLEASE PRINT OR TYPE
Name (First)
:room C ('c~ i 9
Groom's Age v
;;~ateof b -- ;) - 70
Residence (County)
~ (3,vwt;..rJ
Date of Marriage
or Period Covered
I by Search
Place Where
:=was vvCt,of! v('1er~
(Middle)
(last)
ol;.;et',
s
(State)
FL
~-/t.-oo
'-::01.1 h I iJ 7
Name (Fnt) (Middle)
:ride AIl,'s. 0/1 f)
Bride's Age
~of cJ - :;1 - 7 if
Residence (County)
:00. O,,{ fe-he ss
If Bride PnMousIy
MmriecI. State Name
USed at That Tune
Place Where
Marriage W.
Performed (I() <.::tfl!' ;"/ crs
(Last)
ef'/1f ~('O
(State)
..1U7
Fct/A "V!,
I
~. ,\. .r' +<:.:'~:' ....;:.:: :-}~~s~ :.N '::: ....: . .. ,. .' ""~'\"'~'. :::~.:\. .'. .>,' .~. '.\L..~i
For what purpose 18 informatiOn requIred?
~ fl. d J'l'l'lrr iC d i,l {t. (_It ....f/'( to
{J
What 18 your relationship to person whose record IS requested?
If self, state "self: S e /+
i:;;;~,1;}~;~~'1;/!;:~:;~k,'.?;;:':"'~..:<..: ,". ; .~... '.. '" ..... .:~."'~:;~':.~~..:. .':.:'~:c':'.:-:.:::s.-:':;>;;.l!::itl~
In what capacity are you acting?
.;11 y :> eJ.f / & f'c/L; /"l
SignatUre of Applicant . .
G~- &~..z,..&~-
Address of icant
'i 7 /1) t I~e dC-fCll /f""?!
'C/I).
PC'/"! "1"0 6C4cA FL 3Jo6:J.
DOH-301 (3/93)
If attorney: Name ancI relationship of your client to persons
whose nariage record is required.
./V / .A
Date
d - ~- II
Please print name and address where record is to be sent
CtC\'fI 0 Ii vC4'i
'-f Lf tV, Pc de./'c.{ /
p CJ ...., a J1 C'.
II (~'l - ";l J ;)
'530(,.
(PLEASE SEE REVERSE SIDE)
February 5, 2011
Town of Wappingers Falls, Clerk
Dear Sir or Madam:
This is a formal request to have you send me a certified copy of my marriage license and who performed
the service. You may send it to me at the following address;
Craig Oliveri
49 N' Federal Hwy.
#212
Pompano Beach, FL. 33062
Enclosed you will find a check for $10.00 payable to Town of Wappingers Clerk. A color copy of my
license is below. Thank you for your help and assistance.
Sincerely,
/ .'C3~'
L.~
"'...~
~
Ne\~~ PubliC State of Florida
l,illtle Cruz.Oeno
My Commission 00852749
Expires 01/1912013
Craig Oliveri
Click here and typ~~~~~tle]
t > '~;'
,~
~
~
.,
70188&1fO .
[STREET ADDRESS) . [CITY/STATE] . [ZIP/POSTAL CODEI
PHONE: (PHONE NUMBER) . FAX: [FAX NUMBER]
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and D
Certification Fee $10.00
per copy
A Certification. an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties. their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports. veteran's benefi1s, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
~room t tA-\ z.,
Groom's Age a
~~ate of 1 ?- - ct' - ') \.
Residence (County) (State)
~room ''375 /J11 ; I
Date of Marriage
or Period Covered
b Search 6-
Place Where
Ucense Was
Issued
(Middle)
(Last)
e'Z--
, \
C-
1-(J4-
For what purpose is information required?
J-Ir~i ibU.~~ ~J'1 '
In what capacity are you acting?
.~
of Applicant
3'1tJ .Qll Jt-hS-el
\t, we \ l. ::r-~,
DOH-301 (3/93)
(FIrSt)
(Middle)
(Last)
L €.-z-
Name
of
Bride L
Bride's Age
or Date of
Birth
Residence
of C
Bride C~. '
If Bride Previously
Married. State Name
Used at That Time
Place Where
Marriage Was
Performed
\\
-
,~
(State)
What is your relationship to person whose record is requested?
If self, state "self.. .
__...._"._.e
If attorney: Name and relationship of your client to pe~.ons--
whose marriage record is required. "
d.--
I - / /
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
J
'0
I
..........
(V) ~
1\(,\
1\::
"
+t
...,;
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
but
(Ylctrclt
(County)
(Middle)
Gor
(Last)
k..o (, h
,'1 (p 0
(State)
O~,
0),
200+
For what purpose is information required?
-fot~ S ~ y t I rl krt\tt- h Q"YtoJ
In what capacity are you acting?
Address of Applicant 0'
~} J'w~01 rile,
L0u..pp'- ~ ~tlf. V)-cNV 40,ii IJrr:'jV
DOH-301 (3/93)
Name (Fnt)
of
Bride
Bride's Age
or Date of
Birth
Residence
:ride C~(;t C'
If Bride Previously
Married, Slate Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle) (Last)
t2OlC.tA 1- q /3tuv1-t M
7,1', ICj1~
(State)
C)
V\Ihat is your relationship to person whose record is requested?
If self, slate -self.- rel/:=;
,
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Please print
~b 10 I ~Otl
~~~~~\J7~[Q)
l
(PLEASESEEREVERSE ~OWN OF WAPPINGER
TOWN CLERK
~
f"
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriage Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
r\7l Fee $10.00
~ percopy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
IRl [E rr; UW[E i!t
1 2011
TO.(PJ,..EASE SEE REVERSE SIDE)
WN OF WAPPINGER
TOW~_c;LERK
(Middle) (Last)
7J;;~ fYlC?n art-I/O
-:::f(..\IIe.. ;2 3/ I? 8 (
(County) (State)
8/Cf! ;!.EJo8
For what purpose is information required?
PC{ 'nfort fl~me.. C~j e.
In what capacity are you acting?
DOH-301 (3/93)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bricle Previously
Married, State Name
Used at That Time
~Where .~+ "-
MamageWas ) -- Pr.-sb..k.~.",., ChloFJ,
Performed <:. J I
(State)
/'IT'
(First)
:jt;(./ I ~
(Middle)
Sfe. Iwtu'<.
(Last)
fJ1t?ft ,,-, I/o
~ ~/?81
(County)
Ojl1.~$7
What is your relationship to person whose record is requested?
If setf, state "self: .
5eJ\-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Please print name and address where record is to be sent
mCt~7orl' lib
1m S'f
AlY IJ5G1
eft '~- ;",1 4. ..
~..r ~M
, ': , : 02-22-1-0 ElCI'lRES 03-Q2-18 ~II; I.
.,. I' f -J f ..
--- /. ,. c1 l>' f: ""
f'
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coe.v of Marriage Record
Search and
Certification
~Fee $10.00
W ~r copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
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.
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
. (F~)! (Middle)
'//57/44
(last)
d/?e
(County)
(State)
For what purpose is information required?
dytJ/c e
.
What is your relationship to .pe~whose record is requested?
If self, state -self: ~ / "
In what capacity are you acting?
5e/~
,
If attorney: Name and relationship of your client to persons
whose marriage record is required.
,x'.
Address of Applicant
02 r I//at//C' /I ~ I-
~~ ~ 1011 ;tl.Y /dtfO /
~b: /'/
--,J;7a-;;V~m9besenL
~//e/7 SI .441'5/0/1 ~/'~()
DOH-SOl (S/93)
(PLEASE SEE REVERSE SIDE)
r
~
I
"'-
<0
\
'0 ~
'0 '"'.
0
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of MarriaQe Record
>:~ S" c. '~~~?k! '. c . . c .'~.'. ,';' ~<. ~~J;.
Search and
Certitlcation
D Fee $10.00
per copy
A CertiflcaIion, an abslr8ct from the rnerri8ge record issued
under the 888J of the HMhh Deper1ment. incIudee the n&me8 of
the contracting perties, 1heir reeidence at the lime the license
was issued 88 well 88 dale end pI8ce of birth of the bride end
groom.
A Certification may be used 88 proof that a marriage occt.II'8d.
SefRh end
Certified Copy
1\71 Fee $1 0.00
~ percopy
A c.tified Trw'l8Cript include8 all of the items of information
occurring on the original record of the marriage.
A Certified T~t may be needed where proof of
p&rentage m'Id certain oIher de1aiIed information may be
requi'ed such as: p_por18, vet8Iw\'a benefits, court
proceecingB, or eettIement of an ......
;,. .' ~~~.' '"" . " " ;:;:' :~;.f
PLEASE PRINT OR TYPE
Name (FIf8f)
of
Groom \::\ <""- ~,
Groom's Age
or Dale of
Birth
Ae8idence
of
Groom ~
Date of Marriage
or Period Covered
Seerch
Place Where
=Was WCl.~~\V.~C>>:s ~...\\~, \jY
(Middle)
(l.a8t)
?e.....~cc...~
C\ \ ,\.0 \ '-'3
(County)
(Slate)
\(
\0 \ "'\ 800
~c,"'~_Qo,~
In what capacity 81'8 you 8C1ing?
N8rne (Fnt)
of
Bride 3~ o-c...
Bride'aAge
or Dale of
Bir1h
Reeidence
of
Bride
If Bride P~
M8Tied, Stale Name
lJHd at That Time
PMce WtMn
Marriage Was
Pertormed
(Stale)
W~
-:s.~ ~ c.'r-"" ~ "\...J-.)~'<--. e.J\ C;...<"\
c....~'-', <::...'<-t, <;?C>-)'Q"'~';N::~., {\'\
If anorney: ,..,. a1d reIation8hip of yol.I' client to persons
whole maniage record is required.
S'
. ~ , . .........
. . .
^. .- '.
~~, '. . ~ . . . ~~.
Date
00H-301 (8I8S)
(PLEASE SEE REVERSE SIDE)
MAR 0 8 2011
TOWN OF WAPPINGER
TOWN CLERK
i2,J)
f'
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe>' of Marriage Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
PLEASE PRINT OR TYPE
Name S-' (First)
~room fA rJ
Groom's Age
or Date of
Birth
Residence
of I I
Groom '-r
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Mple>
(last)
,A-
For what purpose is information r~ired?
--.NUl) N'(w brlv f:1l-~
In what capacity are you acting?
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.
Name
of
Bride
Bride's Age
or Date of
Birth
:esidenC8(}
Bride lJ tj
If Bride Previously
Married, State Name
Used at That Time
Place Where /"'
Marriage Was ~:...,--
Performed ',.
7\ (State)
ur. iN APP
us
What is your rela~ to .person whose record is requested?
If self, state -self.- 0f: L- Y
If attorney: Name and relationship of your client to persons
whoee marriage record is required.
(2e3 cf
DOH-301 (3/93)
[PJ~~!) ...
MAR 0 2 2011
TOWN OF W
-IQ~ C~:k%GER
--.....-.-..
(PLEASE SEE REVERSE SID
f'
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriage Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department. includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride ancI
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 ancI 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)
~room"? f.,i € P- \(,c;t0N~ I\-\
Groom's Age. J J
~~ate of l '2.)~ ") ,~(:) ')'8
Residence (County)
of .
Groom D\A\-ch-QS<::'
Date of Marriage
~ ~=hCovered 7/L ~ / I 0
Place \Nhere
~c:'was \Ow(\ O~ ~
(Last)
lSAN
(State)
"NY
For what purpose is information required?
~e(\e w \?CA.~<;'~c)\\-
In what capacity are you acting?
(Middle) (Last)
S\"\.I\ ~N ~~\LL(T
2J "2-7/r"?Cj
Name (Fnt)
of
Bride VA,(L\C\r:\
Bride's Age
or Date of "2 L.
Birth J
Residence
of .........
Bride .v~""ch.E c::;,,<::,.
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(State)
l'0~
(County)
What is your relationship to person whose record is requested?
If self, state "se1f: se \ -C '
If attorney: Name and relationship of your client to persons
whose marriage record is required.
(
Address of Applicant
~I COS' (Y\\0~ ~\.
Wo-p~\0--~e.~ ~GA.-\.l';, tJ'l
J \ L..':::; C\ 0
DOH-301 (3/93)
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
v
~
~ ~.\
-
'*
~
lA
"-
~
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health 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 maniage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passpor1s, veteran's benefits, court
proceedings, or settlement of an estate.
(Middle)
Name (FII'8t)
:00 1 ~
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
~=,~~:;~e \. A/uK () A) I S
Place Where
Marriage Was
Performed
(Middle)
;<J
1- 14- t..f~
(County)
(State)
/lJ\.
For what purpose is information required?
JYna'lJ2iQcJf2- !Jc4e ~ oj ()/ 01./
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.
Applicant
i'7)) Y.lVn ~I cU C-)(tdL
~IJ'-I 1:f-\VcY
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
f"
r- ""~
"
r-
C'..:; ~
)D
'0
0
E)'
NEW YORK STATE DEPARTMENT OF HEALTH
Vita! Records Section
Application to Town/City Clerk
for Col!)' of Marria~e Record
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.
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.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefils, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle)
~room ;2 d 6 r ,..4- ')
Groom's Age
~~ate of ) '). - 2- c,
Residence (County)
~roorn 0 c./ f c /.."" S-5
Date of Marriage
or Period Covered /'
b Search J 0 - J~ - Ok:>
Place Where
Ucense Was
Issued
(Last)
;::or1/~
Name
of
Bride
Bride's Age
or Date of /
Birth i e; - J8-7
Residence (County)
:ride 0 u +~ i~5
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(FIrSt)
-rt to t,..~ c,
(Middle)
(Last)
ko5J, J.r.
-70
(State)
IG'
(State)
IV \
For what purpose is information required?
A) rJ/J..j, ~ h
.
'Mlat is your relationship to. person ~ose record is requested?
If self, state -self.. 5 r 1-1
In what capac; ar; y;U ,ng?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
cJJ ofPrn jC'.y
JJ-~96
DOH-301 (3/93)
dO~ fllLI
# II
'-J3-Q7
Application to Town/City Clerk
for Col!)' of Marria~e Record
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Search and
Certification
D Fee $10.00
per copy
A Certification. an abstract from the marriage record issued
under the seal of the Health Department. includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports. veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE D
Name (First) (Middle) Name (FIrSt) (Middle) (Last)
of - of ~\ L.~
Groom J Bride
Groom's Age Bride's Age
or Date of t- ~1- V or Date of t.,
Birth Birth
Residence (County) (State) Residence (County) (State)
of 1)"" ~.) Qv of
Groom Bride
Date of Marriage If Bride Previously
or Period Covered ~1 ~ ~l7o Married. State Name 12-
b Search Used at That Time
Place Where Place Where
Ucense Was Marriage Was
Issued Performed
For what purpose is information required?
~~<9~
What is your relationship to person whose record is requested?
If self. state "self" ..5uff=- .
In what capacity are you acting?
~I~
If attorney: Name and relationship of your client to persons
whose marriage record is required. IjJ /1'-
,
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Signature of ApplICant
Date
3/3 it I
Please print name and address where record is to be sent
rJ
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
i
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
~ ~$10.00
LJ ~~ copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department. includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
(Middle)
(Last)
CJt(\~<;
'^,
(State)
rJ
For what purpose is information required?
~t: ~< ~f\Y!L
In what capacity are you acting?
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)
1~1 S~"'-
s<;
(State)
fJ
What is your relationship to person whose record is requested?
If self, state -self.- .
<;~ l~ C. W\Pe'
If attorney: Name and relationship of your client to persons
whose marriage record is required.
/73)~(G --
lI/1 r;:::::, -.-----
G! ,S in \.\/; (i=
.-'::::J ,J 'J !-S 0
~ MAR 2 8 2011
OWN OF
TOWN IJCVALPPINGER
---=--:.- E R k
(PLEASE SEE REVERSE S
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certification
D Fee $10.00
per copy
A eertifiGation, an abstract from the marriege record issued
under the seal of the Health Depar1ment. inclUdes the names of
the contracting parties, their residence at the time the license
was issued as well as date Md place of birth of the bride and
groom.
Seerch Md
Certified Copy
O Fee $10.00
per copy
A Certified Tnnscript 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 Cer1ified Tnnscript may be needed where proof of
pnntage'" certain other deIaiIed inform8Iion may be
required such as: passports. veters\'s benefits, court
proceedings. or settlement of ., estate.
:~ ::;!1':;Z:!>:. :~, :~::: ' . "',.: f . ',:' :i. . :11}
(Mickle)
(last)
Name (F181)
of
Bride
Bride's Age
or Dete of
Birth
Residence
of
Bride
If Bride PnMousIy
Mmied. Stale Name
Uaed at ThaI Tme
Place Where
Marriage Was
Performed
(Mickle)
(Last)
(State)
For what purpose is information 1'eCfJired?
1SQnef;~ \hrlllirrli(JY)
In what capacity are you acting?
S;Sl ~
If atIom8y: NaT1e and relationship of your client to persons
whose ft.. iage record is required.
. t
/Dq chdSea.i~ad-
\AppIYJ9h~ -f{rI!J I ft?J fJ.ffi)
SAmE
OOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
.
v
i::
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\-~
--~
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~
~
-1: ~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee$10.oo
per copy
A Certification. an abstract from the marriage record issued
under the seal of the Health Department. includes the names of
the contracting parties. their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
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 setftement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last)
~room Jos E..p tt R lA 6-6-1 61 0
Groom's Age
~r';.ate of (l I C) 'O} I q hq
Residence (County) (State)
~room l)uJ-e ht S.s. J'f
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was W^
Issued lA-
2DDS-
For what purpose is information ~ired?
C_CL-{~'1 (J lOCLR J \ Ylj
In what capacity are you acting?
s"Q t P-
Name (FIrSt) (Middle) (Last)
:ride f: h()r1I~ r?O~c. 0
Bride's Age I
~ateof 3/1 J977
Residence (County)
:ride D lA.k l1~ .s
If Bride Previously
Married. State Name
Used at That Time
Place Where
~==:- P D U 6--1+ KE <:?P.r J E
(State)
r/
,J)'4
'Mlat is your relationship to .pe~ whose record is requested?
If self, state "seIf.- 5€ f +-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
pplicant
14S Rob,'n'5c!h ~
WOJ(tln$v.J' fc..fJs tV'1 Iz..~
DOH-301 (3/93)
Please print name and address where record is to be sent
r hI) i~:::; 0('
iJ 11 L~:; \ (;;
JUN 0 7 2011
TO \tV f\j ''''"""
~ t ,_if'"
TO
----.:-
(PLEASE SeE REVERSE SIDE)
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Application to Town/City Clerk
for COe)' of Marriage Record
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
;;'::>C;~';;.:';fi!li;:""x~ "~". . " ,.:~'~:< . " . '. .L: " '. .'^'"~~/,J:;~i~;
Searoh and
Certification
Sea-ch and
Certified Copy
~$10.oo
lkJ ;; copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
D Fee $10.00
per copy
A Certification. an abslract from the marriage record issued
under the seal of the HeaJIh Department. includes the names of
the contracting parties, their residence at the time the license
was issued as well 88 elate 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 selllamellt of an estate.
"~~;;~?t)/1~;'?\/;'~':.' .:',' . . . c, ;/0{:;":'C:':: ,,:^;c:~::.:'<1&,J
(Last)
~
/5@;6-'
(State)
AI, .
'nwhat~7ting?
What is ycu- reI8IioIlIhip 10 person whose record is requested?
.....- '!)
<. R/~
If attorney: Name and relationship of your client to persons
whoM marriage record is required.
D0H-301 (SID3)
(PLEASE SEE REVERSE SIDE)
Date
June 02 ,2011
I am writing this letter to requested a copy of my marriage transcript.
Thank you
'.'/~'-"'''''''-'''-''':'''''''''';''''''-''<''''''''~''_.''''''''''''
OFFICIAL SEAL
f NOTAHY PUBLIC, STATE OF WEST VIRGINIA
/~, MARTHA A. BLAKE
~ LEWIS COUNTY, SHERIFF'S OFFICE
... P.O. BOX 150
WESTON, WV 26452
::,Y COMMISSION EXPIRES JAN.11, 2012
.~~...~.P'''''''-
~ . / f
Cfl;d1U;~ .
() 0 - 0 d - II
.liII....,'...' .
'i ..
Ii . .
i1
\
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
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.
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.
l{J
In ~ity are you acting?
_\ J!.. ( I 1 I 0 tiE ~
If attorney: Name and relationship of your client to persons
whose marriage record is required.
I 1.. 5' 33
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
J
y
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
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 \Nell as date and place of birth of the bride and
groom.
Search and
Certified Copy
~f\'"J- 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.
_'x'X.-."'...........-f.....-.-.N.::.-.<<..... ....~,.;..{- '>>....-.........y~w.x::.-" ........~~.....-.. :::;x.. . ......>> -:..."..-/....=5>>....-:::;(.<..... .{>;>.-<<.-<<.-~...<<::::K~_@M..:::...;.~_
t;Y',';\.:3~A?; ;,)<:<::! :~~..7;; :~:.;; :,:::' ~.::<;>~:: ~':,'.. ';J;:',' ;,}~.;v:; .".:>~ ,:~'~i.I;(\:'Ji~: '~wh~ik?
..>>.:)w:.....;:..~>>.&:>tyM...-::y...>. ..w..>>-::..Y<<-:...;..<:.>>: :?l'>> /,"'. .-:...:0. >.... .. ..... ....;.}-:"'..::;.......::::....::-.....:::w......>>..dN.v: ...N.....h...-::~:-...:f.:0:W$...~'*.W ~(<::B.~;~
PLEASE PRINT OR TYPE
Name (First) ~
of
Groom
Groom's Age
~~ate of 10 - J!J- ~
:eside~ JJ (County)
Groom '!JI Ii..
Date of M e
or Period Cover
b Search
Place Where
Ucense Was
Issued
If4~lti_1IfIj_~ij'c,:i:;::?:~:~:;~;g&:1:"2/~~!:;:.~l?i;:1':'~~::.t: {~:~. ~::~.":h:r :'. ::.~;.:~'~;:..~. ;~. .::.,~?';::t,:':;:~~CXf:ijy?i0)J).?~iTI\ii;:;.f@1~1w:t.2J1:i
Fo~1S Information ~Ired?
" ~~
In what capacity are you acting?
_. _ ~ iP. .person whose record is requested?
If self, state -self.-
,
If attorney: Name and relationship of your client to persons
whose marriage record is required.
(PLEASE SEE REVERSE SIDE)
~
;
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v
'--
--..
~ \). \
~
~~~ ~:\t
t
v,
U -~ ~
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department. includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
;_<:@?~~~0;}1';;)~::;:0g;~";71i~r:~~~ <:':>1r~"~'1~<(('~"~~~ ^f, ~~ '; "c:""'.'~" :'~';~<;~~>:-; ;~\<;'<~~}~~:'~:..:'Tl~.k*l:~Bt.}'%l_~m;t;
:;:;:.,:::,:*i","",:.,,_~<,~~f..m:>W":::::.,"':,::(<>:,,~, <. w' ,,-,,"'v:"'"' '.N' .}>> .<m:'. ,.,.<< ,., . ,., ",<<':n ^.....,::;" ".<""~" .0,""~,:,, . "'//.w:>,..<:::=m,^,ml=:::;'&@~.',3:"""'::;;..w.&.:::, ]Bi"
PLEASE PRINT OR TYPE
Name (First) (Middle)
of . --
Groom LDd l! (1 y I,
Groom's Age
or Date of
Birth .5 l ir (c =>
Residence (County)
of .-~
Groom l..A-..'l+-c:1. -€ SS
Date of Marriage
or Period Covered
b Search
Place Where
License Was
Issued
(Last)
0J<)~
(Slate)
l\.f
For what purpose is information ~uired?
Y\.X1! C~ p. C~ W Pu.sc~PO(-t-
tv ~'\fuA) (\~) nO-.rrJL
In what capacity are you acting?
(Fnt)
(Middle)
eJC
(Last)
Ve
c
Name
of
Bride
Bride's Age
or Date of
Birth
Residence (
:ride ~t
If Bride Previously
Married, Slate Name
Used at That Time
Place Where
Marriage Was
Performed
-wck')lY\ ,~JL
What is your relationship to ,person whose record is requested?
If self, state -self.- S~ (-{1
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
Q
Please pnnt name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
J
r
-,
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
~ Fee $10.00
~ per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
(State)
N.~
Ob
For what purpose is information required?
o-Q vnCl(CllA ~
V\ DY\
In what capacity are you ac~g?
)R \:f:
Ad~7)qPPlit~1-~ qi)
tDc1tl^~S ::r-oJ\\) N.Y,
j). ~q 0
DOH-301 (3/93)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
:ride \ J-\ c1t5 <; Lov()l-
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
s
(State)
VVhat is your relationship to person whose record is requested?
If self. state -seIf.- <S ~\ .q
If attorney: Name and relationship of your client to persons
whose marriage record is required.
\ \
Please print name and address where record is to be senL
(PLEASE SEE REVERSE SIDE)
----
~
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\
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~
~
D
~
4l
-
'-..J
--c..
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
rr:1fI1f' Fee $10.00
~ per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
Fee $10.00
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 seUlement of an estate.
""""'=[1'-" ,_.r ,. "X- . v..,..' ,....^.w .,. .... .y;. .w,.v....:., '.' .,..,>, 'V..W",,' ~,^' .." ... .v.. .. .....v .,..'.N....W.. "', ... .. d.'" ., . ~""'''II.'''...' '''..w..'..''......._
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f(:>;:;;; .; ii\-%~.;:<:>~2...?}>t\ :,;~, :?::,: .;~.:'~'< '.:;; t.:.: .:: :. ,,', '. ':":..,' : ';~:;i.;;' ~ ';: ,~: . >.i ~;.;y..ti:f"'{ };F~(:~:xJ~~;:: \{~
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PLEASE PRINT OR TYPE
Name (First)
of --
Groom I J-t./ t:::
Groom's Age
~~ateof i:A-.'/~ Jq 5
ResidenCEl"tL (County) (State)
~f ~\ 't}:;;L1,4 f)./rrbl'v
Date of Marriage
or Period Covered
b Search
Place Where
~=e was~tVP of IV ftffl'!V6el- ~
p-L
Z? ,'170
For what purpose is information required?
OCC,4,1- 5e:tJ//t'll CAl-.j)
'!Azl J'C/j '-IG t.e-A.;:EtvI1L
In what capacity are you acting?
512 L- r
s
(Last)
fYJA jVES
I t~ . I q 66
(County) ~A ~ J (State)
gt:(;j 1A1t1V F t
fJr
, I3E.AcoN
Name (Fnt)
~ride mAVa -
Bride's Age
or Date of
Birth
Residence .~~
:ride ~ &
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
V\lhat is your relationship to person whose record is requested?
If self, state "self..
SGJ- F-
.....
If attorney; Name and relationship of your client to persons
whose marriage record is required.
Ad r of Applicant --
9D2...:5'''7 ~y /.")~1 e I
/} /l kl .:S.oll tyj FL
crOtt-rTt--- or' )) 35071
DOH-301 (3/93)
.27-2911
Please print name and address where record is to be sent.
fY>au.rr:er> ktJ;J/~15~.
IO~ Har-l::.or 1/7 /J C I
~c~J '5f/!-, ..'l6-j ~ 3307/
(PLEASE SEE REVERSE SIDE)
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Florida Department of Highway Safety & Motor Vehicles
Division of Driver Licenses
TEMPORARY DRIVING PERMIT
"DL #: R152540606460
License Type: E
Name: MAUREEN, ,ROBBINS
DOB: 04/26/1960 Sex: F
Mailing Addr:
10259 HARBOR INN CT
CORAL SPRINGS FL 33071 - 5624
Residential Addr:
10259 HARBOR INN CT
CORAL SPRINGS FL 33071 - 5624
Height: 5-3
Issued: 04/22/2011
Expires: OS/22/2011
Period: 30
Motorcycle:
Restrictions: A
Endorsements:
Remarks:
PENDING SOCIAL SECURITY.
/"
BY THE AUTHORITY OF:
SANDRA C. LAMBERT, DIRECTOR
DIVISION OF DRIVER LICENSES
PHOTOCOPIES ARE NOT VALID. MUST HAVE ORIGINAL SIGNATURES
"NOT FOR IDENTIFICATION PURPOSES"
www.f1hsmv.gov"
- - ---- - - -- .-.----..- -_._~.. .------------------.' ,----- -- -~-_.._---
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
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.
Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports. veteran's benefits. court
proceedings, or set1lement of an estate.
(State)
~
What is your relationship to parser. . ,ose record is requested?
If self. state -self.- ., 5e 1* "
If attorney: Name and re1ationship of your client to persons
whose marriage record is required.
of Applicant
I/J(p )/-//lcveJ Av"v~
..lid y- / htJrcJ .A/I /Zr/2
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
F
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certification
rl/'Fee $10.00
W Per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle)
of '
Groom JOSk \1 "2
Groom's Age
or Date of
Birth
Residence
of D
Groom ,. ...1'"k"'(2.':;. 5
Date of Marriage
or Period Covered 9 - 1- \ - 2. 0 I 0
b Search
Place Where
UcenseWas tuVJII" ,,~ Wcl).() p~ ,,~c..r
Issued \'
(last)
(Z 05 S :
(State)
,0y
Name (FIrSt)
of
Bride p. r ; c.. ^ "
Bride's Age
:~ of ;) - DG - 8 '1
Residence (County)
:ride OJ\c.. '-'.l f(
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle) (Last)
!: t h tt f1bRr-1 e r
1-IO-'iJ\
(County)
(State)
A.J~
For what purpose is information required?
\ v';.\- 0 \ 6 0 V\ .Il.
What is your reIationsh, ip to ~rson whose record is requested?
If self, state "self.. <; e \ .(.1
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
We.. p (J ,- 'l) er J ell / ~ 1ol'1
Please print name and address where record is to be sent
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coe.v of Marriage Record
:~'::,~;?, ".<0.ff~0,:<x' h. " ""'> ',Y , . ;;,:/....' >",' , ::t' ::i:-rBiC
r7f Fee$10.00
t.Jpercopy
A Certification, an absIract from the marriage record issued
under the seal of the Health Depar1ment, includes the names of
the contracting parties, their reeidence at the time the license
was issued as weB as date and place or birth or the bride .-lei
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Search .-lei
Certified Copy
D Fee $10.00
per copy
A Certified Transcript indudee all of the items of information
occurring on the original record of the marriage.
A Certified Trallscript may be needed where proof or
parentage and certain other detailed information may be
required such as: passpor18, veteran's benefits, court
proceedlllgs, or setIIement of liIn es18l8.
. " ".:'~:<<< .~~:'" . ':' . , . q ". -" x." " '. ,,'" '~~;~/.; '~:~j; .'~
(Middle) (Last) N8me (Fnt) (Middle) (Last)
Nied2.,~.H~\ of Jo rV'\I')~ ....... l
--. pt.~' C(~
Bride \ ...... '\c...:
Bride's Age
)V or Date of 3~
Bi1h
(County) (SIBle) Re8ldence (County) (State)
NY or Dv+ LV) ~..... S> N'I
Bride
1\ I If Bride PnMousIy
~ I \ \ Mmried, S.... Neme It gl I \
Used at ThaI Tme
Place Where
Marriage Was
Pertonned
For what purpose is information required?
J O1al)1- vYJI.-( f~
In what capacity are you ~r}?
,~L~
Cl
"./(.
f:;'d I sIN Y I 2 sc; 0
D0H-301 (3/95)
If anomey. Name and reIation8hlp of your client to persons
whoM nwri8ge record is required.
J (
PIeMe print name and address where record is to be sent
IV~L\ 1)ou~\C\..J
t1 f'f, '1 )\ is Dr; \1"<.
W~p d)~5 ~lls) Ny (2sqo
(PLEASE SEE REVERSE SIDE)
~
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marria~e Record
~_R~<:~d;'~.:~k;;'{:i:~'i0';~r~;~'.';':~':t';'::::)':-" c..,,": .' ,~. "~, :"":',~ '\:,~.:'~~':F~/S:::;~~?;!;i7:'~{i;t~*t'Mwflm1m[#l&f
re~ ;:x:.:~w:'X:-::>"':~:":d....[>::}":~!C:~' .......::t',,(.~ ..... t..................'^'~...... ..... ... . ..... . ...... . .." ...;....... >.:-:..x>v....{..{::v....:<<.{....:<'/.......:%x...:-.:...~~1f{~~.^....::;:c:,>>:::,:<=...>>;.:<<~~m.
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
~@.[tmWimSWi{:!jit~;t~~.:i2::,./,:~i;:i:.~..~.F?:.Y.~:.,;~> ~';.."....~:: {; : ,:' ( '~:':' . '.".. :.; '.':, ""':3J:~"~~' ',. ::'> ::' ~.,.:,:;. ~:. ': :;~~TI&~*:IS~t-1~q~I~%t@\tWWM;
:~#~~_i%.y~.....z:-.:-."...-:;.r<:x.;..:.::.x..~:x6 >>-."" 0..<<.::..:: .........."...:. '.x.;.:"",,, <<.:-:..' ....<;;;.-; ...... .-::........ <= ... '....... .....:-.x" ...".. ...v."....N.... ....." .... {.> ..".:.... ....~....:.::....~<<......:::-:<<.x:-.......~<<-:..,,~.....~.
PLEASE PRINT OR TYPE
Name (First)
of (i l.. .
Groom U ,,,-,&-\0
Groom's Age
or Date of 1'\
Birth '-t"
Residence (County)
:.oom D v-.t. (~e s.5.
Date of Marriage
or Period Covered r
b Search \-e. '0 ("
Place Where .
Ucense Was \0 6.rvl\.l\qL xC \='J+- \ \ $
RUed -~- .~. \
(Last)
\I.S5MSv;. s
.,\30 \\C\ (p9
(Slate)
N.
\ ~ \q<=tZ-
For what purpose is information required?
r ~~ ~D( 50l\'s pu.oo~
In what capacity are you acting?
(Middle) (Last)
E\\LQ~ VI~0.S.v...vS
C)\311'1~V
Name (FIrSt)
of -
Bride ~ 0 LL
Bride's Age
or Date of Ll 'I
Birth 'l 0<,
Residence (County)
:ride D u..=r Gh~s <:
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was WI) Df).. 0..</0 IT
Performed --r r . ()-
(State)
\0.
V\Ihat is your reIa1ionship to person whose record is requested?
If self, stale "seIf.- .
S'~f-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
("1. rCj\1 ..1.., '1.
DOH-301 (3/93)
Date .
7/'2../ /'2..01\
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
_0';:'::::"~;"'~'';'''''{::::-0y....:::>.:-:-.;->~m...~"..~.,x. .$:....,::.::-:..X~~,....,:...-:..........;..~.,........:-..::. ;ox' .; ........;;:.~... ..........:-x.:.:<;xo"...;... 'V'.....;.;..;::^.....<<.;:.~:-...;.;:::.::..:-:)tI~~.=>>.~~_*:~
~*Jfif.Jb&I%k4;k~:;:,.,~.~:,j:;~ ;~~ ;~ ~< f,:\L';j~. ::.~. ~~:.,',::;.~~. ..~..;~:'xl..;1.:;: >>:. .:.~;{}:d,~";.~~K~Fif.i4i.W:~ I
PLEASE PRINT OR TYPE
Name (First)
~room p
Groom's Age
or Date of
Birth
Residence
~room DLJ'R . e::SS
Date of Marriage
~ ~=hCovered / i 3.s
Place Where
:=:ewas tul4lrllJ'~f.5
(Last)
Name (FRt) (Middle)
:ride Yl<
Bride's Age
or Date of
Birth
Residence
:ride ly.) 17!.t(ESS
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
erformed
(State)
;J
(State)
N
For what purpose is information reqUired?
PIrSSf6f7'" '.: .... , .
'Mlat is yo.,r f81ationship to person whose record is requested?
If self, state -self.- . ~ a....F
.. " .
c)t< 'i
In what capacity are you acting~
5~L-r
;~'" "l f~ . .'
~' r "
If attorney: Name and Ip of yout client to persons
~ marriage record is required. ..
""'''''''-.,_ .>.......~..,.. e., ", _ _ '.>< 'it
. ~' . ,. .
(0 rff
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
i
.\6~ .
\ IA~~
..
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for COe)' of Marriage Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
_~"'';~''''::::}';;~~';'''XVl<</.~~';';':;:~~,,,,,;:,-,,"Y,,,,,,-xv,,,~,,,,-:>>,~::,,,X....(<<~:,%:~".-:-... '.t;.:..Lf y;. . ....~..%.."'V . ;;...{%...=,~.:'.;.c...:%s:y..rw:."..<<:-v...<....~.(.:::.-r::.-m.;:::' :'''';'X~~:3*:'':::;;Wi~_
%iWiit;:g;~;;i4&fih~~'i<";~~L'j,~:;:/:;<\:.;,;":S;~ ..: ..L:;::;/." ~~::.:~:,:::Zi;'..:;..;:;;ii:.';~::M:>r;:U.;;ix:)itt;jw$f&mmJi;~
PLEASE PRINT OR TYPE
Name (First) (Middle)
of
Groom "-/ I C. ~ ().. A 5. LV
Groom's Age
or Date of
Birth
Residence
of
Groom fJ~COI~C)
Date of Marriage
~ ~=hCovered I 0 2 [) I ~ 0
Place Where
Ucense Was
Issued
(Last)
L L i-l {Z/c::.
q 2 C1!S-)
(County)
(State)
v./
(
For what purpose is information required?
~Sry?D/t;- IrpPt (( .-fi'(" J/
In what capacity are you acting?
.'
(Middle)
(Last)
(f) C/t..> n ,A./
Name (Fot)
of
Bride /.1 (t( D
Bride's Age
or Date of
Birth
Residence
of
Bride D tlTe HIl ').>
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
A-
2- l-z.-y!6J
(County)
(State)
{V''(
What is your relationship to person whose record is requested?
If self. state -self.- S r, L . r
If attorney: Name and relationship of your client to persons
whose merriage .record is required.
lliWVft.tt?i1&~'.1:~::::;::7:;Z':~:::~.:a~<:~..'~ ":::::~1:.: :.:~L:..:.: .... , . " . . ':. . " ,,':. .", . ::.,""'... ...:: :::: ~ ....} .,<;V..0.;:y\'<>~[*lPp.1i%yq;tf-1:
~WM:<<N~" ....%:...~~W;Y. '-=-V:Y":<<':-~:';."~":::":>>:-:{....'. .. '<<-:-'''''. ,..,;... . .... "" '. ..... ..~... .:...<....:.. ............ .::.~/.. ..:.:..;:;:-......;:. .k..:,>~diO-'*"~;>>.$):.~"Y;.)J:~:r%:23%?::W.l~iE
Address of Applicant
):> .svt: I~ v{ (7'-
w A-~ f. r 4'(.. '-) t' ()./ t{
DOH-301 (3/93)
Date 6/6/t 1
PIessft.print name and address where record is to be senl
" ''''~
r
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records section
Fee $10.00
per copy
A Certification, an abstract from the marriage r8Q)rd issued
under the seal of the Health Depar1ment, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passpor1s, veteran's benefits, court
proceedings, or setttement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last)
~room ~~=fB~ ~ (" 1ctDUY'"
Groom's Age \
or Date of l) 9> \J~' 0\0
Birth I\. I
Residence (County)
~room -:Q,~~,:) ~ CCO"
Date of Marriage --:!"'"" \ _
or Period Covered -\ex>f\;;().:' ().JX),~.
b Search
Place Where ,
Ucense Was ~
Issued
(State)
\).'
For what purpose is information required?
T~t~ ~or ~e. t?e~~t1'~e'"\\ ~
~ ~
In t capacity are you acting?
~1~1J '
Ad of Applicant
'5 ~<<:AlOS-~ S\. ~ \; . "J
b-o-cO<\. i ~ 'f. \~c;C>lS
Name (First) (Middle) (Last)
:ride Gb\ c,~ "Vo~-\U(d-
Bride's Age
or Date of -:LC/ \k"~ c \~
Birth :..J I
Residence (County)
:ride ~\-&w ~~. COc.A+
If Bride Previously
Married, State Name ~ - ) .
Used at That Time ,~\O-r
Place Where
Marriage Was
Performed
(State)
tJ:j
~oo~
tu\'f\1\CC ;f;\\s
V\Ihat is your relationship to person whose record is requested?
If self. stale "self:
If attorney: Name and reJationship of your client to persons
whose marriage record is required.
I
;
(PLEASE SEE REVER E SIDE) I
JUN 3 0 7l I :
TO Ii. ,. '\!~ER I
.', K
--~ ---~- ~~- ~--_.._~- "-
DOH-301 (3/93)
: REPUBLICA BOLlVARIANA DE VENEZUELA
MINISTERIO DE~ INTERIOR Y JUSTICIA
D~ECCION GENERAL DE IDENTIFICACION
Y EXTRANJERIA
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o SSE RV AC ION ES ...................................
SE EXPIDE POR PERDiDA DEL
ERIOR SEGUN OENUNCIA POUCIAL.
n..~................u..........*"......................................
SENTO PASAPORTE ANULADO Y
....................................................................
P TIDA DE NACIMIENTO.
.....................................................................
TE PASAPORTE CONTIENE 32 PAGINAS
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REPUBLICA BOLIVARIANA DE VENEZUELA
PASAPO RTE T1PO . TYPE PAIS EMISOR . ISSUING STATE PASAPORTE N.~ - PASSPORT N,U
PASSPORT APELL~NAME ~ 15.101D25
CEDULA DE \DENTlDAD NO - \.0. 'N,"
15.161.126
'0. PLACE OFBLATH
CAPflJl1.
..cHAo.iiEN_2X~RY
. ~;AtmlORm' . ....
~~,~
. NUEVAYOf&:
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
~
A Certification may be used as proof that a marriage occurred.
Fee $10.00
per copy
A Certified Transcript includeS all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passpor1s, veteran's benefits, court
proceedings, or settlement of an estate.
Fee $10.00
per copy
A Certification, an abstract from the m e 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.
(Middle)
Name (Fnt)
of L
Bride
Bride's Age
~~ate of MtI1l
Residence I . 1 (
:ride uJ f)
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage W
Performed
(Middle)
(Last)
tJ/'Cu::'/
72-
(State)
L
In what capacity are you acting?
wuren DR
GorcJ/'ne
Uj?~ / 1 j2eJ /1
PIeas8 print name and address where record is to ~ sent
L'/0eo. Hc.'~(\;Yh l-
N J-Lc{U vC V"' '\)~
,yo GQcrdi(\c(" N,
\ 2. 52..5
DOH-S01 (3/93)
(PLEASE SEE REVERSE SIDE)
.
J
-.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification. an abstract from the marriage record issued
under the seal of the Health Department. inclucles the names of
the contracting parties. their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passpor1s, veteran's benefits. court
proceedings, or sett1ement of an estate.
(Slate)
For wh' P'f~ is information required?
I(J Onj1l /17 (OILI of rrrJ rr;'u f {l
jl(ljt~f' '
In what capacity are you acting?
(Fnt)
(Middle)
(Last)
Name
of
Bride I
Bride's Age
orOateof
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
d-/d-7q
(County)
(State)
What is your relationship to ~rson whose record is requested?
If self, state "seIf.- Sf} (f
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Address of pplicant /) . /'
tf (t/tlrl,l1thll mil.
JQ'tfgsftiJ1, fJij /JlJJ/
DOH-301 (3/93)
P~ print nam!! JA".d address where record is to be senl
na vWlL \\~Ch1e..
1--\ \ C \avinM() 'PrVit
~\() S+m \ t--J\{ \dL\()\
(PLEASE SEE REVERSE SIDE)
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certification
n Fee $10.00
L:::J 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
~ Fee $10.00
L!J ~r copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such 88: passports, veteran's benefits, court
proceedings, or seutement of an estate.
(last)
h !? /'/ tlf/!
:1-91(
(Slate)
j/l ill I.
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
(Fm) (Middle)
f.r1tt~ttll/ [a/{ly!JII
(Last)
()&lR513 r
~) ~ ,J <g .- /fI~{)
(County) (State)
II '5tJ;I !I~:Y
What is your relationship to person whose record is requested?
If self, state -self.- 5 e /1; h 14) b 1/111/
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
;
"
~
;0
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records section
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health DepaJ1ment. includes the names of
the contracting parties, their residence at the time the licenSe
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
- /l> .- ) 9 .::;-
(County)
(State)
In what capacity are you acting?
ddress of Applicant . .
!J t'J 'IJr/ii'.u 11// N
~r V ) Id.~~
Application to Town/City Clerk
for Co of Marria e Record
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
Search and
Certified Copy
A Certified Transcript may be needed where proof of
paren1age and certain other detailed information may be
required such as: passports. veteran's benefits, court
proceedings, or settlement of an estate.
Name
f
ride
Bride's Age
or Date of
Birth
Residence
:ride ~ h e.:55
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
performed
;l.ta~~
What is your relationship to person whose record is requested?
If self, state -self.- .
5'EZr
If attorney: Name and relationship of your client to persons
whose marriage record is required.
~ -3-
o
Please print name and address where record is to be senl
(PLEASE SEE REVERSE SIDE)
1
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
D Fee$10.oo
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports. veteran's benefits, court
proceedings, or setlJement of an estate.
PLEASE PRINT OR TYPE
Name (First)
~room 2. ach Q ('
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Middle)
Pe+-e.
(Last)
Ca. (I
Name (Fnt)
:ride (\9\ \-e;
Bride's Age
~ateof 4 - I ~ ~ <f, J]
Residence (County)
:ride ULA-k c"e 5S
If Bride Previously
Married, Slate Name
Used at That Time
Place Where ( J
~=::as S-r Cv~L-LNv~ " nofeu;e II J
(Middle)
klA re
(Last)
Ca.rr
fL- L ?~<1s (0
(County)
." :\-cYeS 5>
(State)
N{
;---
For what purpose is information required?
r45$pOr+ fY:1.MfJ
What is your rela1ionship to ~ whose record is requested?
~ If self. state -self.- Sr? r II
c 0.J~1"( c- r-'
In what capacity are you acting?
.~(\
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applican~ ~
Address of Applicant Please print name and address where record is to be sent
q &-~avwoocA Dr.
W(kf'r\~r~ 1= a...ll S i f\J\.f (Z-S'7
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
J
v
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Fee $10.00
per COpy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or setllement of an estate.
__!~~~~;;k~:~::: ~iZ1[J;~:,:;~:':~:::";~'::::'i:::~!;'"~"":~:;~:'-~~,:~!~':5C: ":~:, ,": i::""":~:':::[:r;'~: ::"::J:~"::::E~~;:i:" ;,f&~BIYtt;tt~ili~;_t.
PLEASE PRINT OR TYPE
Name (First) (Middle)
of e,du:\() C:..
Groom
Groom's Age \ \
~~ateof ~ )(1 (o~
Residence (County) (State) .)
~room "~u~~~ '()~~~o/l
Date of Marriage (\ i ."L?'\. Z +~ c (',
or Period Covered r\\.)~~\' t::7 0 \ \1\
b Search \)
Place Where ~\
UcenseWas )Q\..l..)1\ ~'W~. \- ~
Issued
(Last)
~~~'L
Name (Fm) (Middle) (Last)
~ride ~\.)s.p\("\\'Y\. D'\~ s t.--
Bride's Age ) \
:~ateof ~ dJ ~O
Residence (County)
~ride ~~~~
If Bride Previously
Married, State Name --
Used at That Time
Place Where \ M \" I \
Marriage Was '{)' ,\\~ ~ 0 '-J,J(~\::x?' s-
Performed
(State)
f\ ~ 'i 011"
For what purpose is information required?
~~\\-'vJ -y-<)~.
In what capacity are you acting?
What is your relationship to person whose record is requested?
If self, state "seIf.a ~L \f".
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applicant ~_
~.....'" ~. ,,-,y\~
Address of Applican~;J ,~
~'J \ (4 ~ \ \ vrf~ .
,-0~P\-::>' ~\'::. . \,)'\.
\~~ot()
DOH-301 (3/93)
Date 1\..
~\.)
J ' "\ \ )001 ')
Please print name and address where record is to be sent
--~..,.~,.,
(PLEASE SEE REVERSE SIDE)
J
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-
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~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
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 li~
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
rvl Fee $10.00
lhJ 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 benefi1s, court
proceedings, or setftement of an estate.
_7&#';<<:>"':>>;::""'....,.....>><;0):" ....,..~..~..;:... 0X%...~%........>....x:-...;.::.......%.~.....<:O ....v.......'i(. ..:-.,...;yx. .... X5='<60'~~W"<<=.:'N",,<<'>>:,,v"~""""""ffi"'''(.'''''''~_~~
vj;~~<~~~~~~>x~~(:'~~~v~~,~~",~;~~"~?'~'*':V>X;:~~:~"'~'<<,:,>.::~~:-~'=,~';m~~~
(Middle)
(Last)
Z- (
(County)
q
For what purpose is information required?
~~~(~.
In what capacity are you acting?
Name (FIrSt) (Middle) (Last)
of
Bride G /l1 e C ItvL~
Bride's Age
or Date of
Birth
Residence (County)
of
Bride ~VPPt>~ M
If Bride Previously
Married, State Name
Used at That Time
Place Where TlJl,.oIU
Marriage Was / ~ L
Performed V-::.;}
V\Ihat is your relationship to person whose record is requested?
If self, state -self.- .
6e,(t
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date
LU :r\2-Z-~ l ,
Address of Applicant Please print name and address where record is to be sent
~t.(f{&.-=ttlAGt tt; 51 Il1D 1t.J{3. he..Cftl/UD CP11-11 LL-
~h>\.A. tl.{~ 62.1 c:} CRt-J~ G -1:t-U: 'Cst ~ ~
Ontlil~~of~IJ~2O..ll.beforeme.the 17D"SWbU 1---1 M ~l-(2:?
~~ 'iU..~ (name of document slgner),
proved to me through IIliIfIctofy ~!E SEE REVERSE SIDE)
idenlIficatlon, which were M-I'\- LA ~~ .
to be the person whole name is Iigned on the
p~~m~~M_
. ~
( ., andseal~)
Uv mnvniIaion 8XDire8: ~ I S- 201 ~
DOH-301 (3/93)
.
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:.).' Alt: UI- NEW YORK
O'EPARTMENTOF HEALTH
AFFIDAVIT, LICENSE and
CERn.FlCATE OF
MARRIAGE
FROM THE GROOM
.- B~nPaul~~
"'!l:Jlll"C~~~
(.,.. ~ Fl)IIt $!'4't is' .1IIil ~1
to.M1"f -tAttches&
C'N'i"QM Waopinqer
:S-":'368
~r32
L 0 SUPPLa.4ENTAJ.. ALE
FROM THE BRIDE
Si~ Oina DeCa. rio..
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l' .. I'lX1 MMfi
-
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c 0I'lECk OlE tEl crrv 0 'fClWN 0 ~ (:. ~ ONE . r:r Ct1Y 0 TOWN 0 vt..UlGE
~1 Boston ~Bo$ton
tl. $T!lU'r~. &48 East 7th St.; #3 ZIP. 02127 Ii snur~ 648 East 7th Sf;.s ~ 0212.7
e.G ~ JIrnII\i l.NlTi ~ CITY 011 ~s VlU..<<1' rf vU 0 NO L IS AE5Ill6HCl: W!llfr; iMTS ~ Ctl'Y O!'! ~1m ~Jo:lf" cf~a Cl IC)
3. A. loGE 3~ . Oot.TEOf MttH ~f / '0./ 197~ ~: A AGE 31 I.OATE OF8lATHOS /3Q ./'1979
· -- A;= M' - cl' ~ .- ~, riM
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$. PLACt Of ."'11< ~~;r~~,~~..., I l~ PLl\C1E OF IlIImi ~h!~ ~~;, ~~
.. FATHEl'I llll F" THSA
"NAME Paul JosephCahin A. NAME PhiliD JoseohDeCario
a c::ooN1'l'f( OF 8lRTH USA 'S.COUNTRY OF IIll'mf U SA
.1:;
>
'l~r
17. MOTHER
A TlltAIDEH MMEBemice Hirschkom
a.. COUIm'lYOF.IIlI'miISraet
11..HUMIEI'l OFnt$ ~. 1
1'~~ MARRIAGES WHO! flNOEO.8'f
0I\I0l'lCE CML A~
o 0
DEATH
o
UOTHS't
A "'eel !!WoE ,Anne HaJoin
Il ClOUNTJ'l'Y<JF llIImI USA
~ OF 'rHlB MMI'IIAGE. .. 1
.~ ~~~esWHlCHENDED av
l:lM:lfIQ!; CIYIl ANNULMl!NT
o 0
DEATH
o
a, ."".1llD lAST IlWRo\Gf; SIlt . 0 ~ C3l 0 NHUIEJrI'l' Q'} 0 WlH . HOW 010 lAST .~ IlJCl'1 i3I 0 llWCl!lCf lJ' :1 ~ 1tJ G tIE-1I<
(), DATE tASY' ~ ENDEl)f .. / / C DATE lA$f.~ ENDEl'.)? / /:'
1olONTlf. ~'I' 'I'fN\ ~ llII<'1 - ~
D.1IIE1<<'f~~~ DYES OHO D.NEAtNf'ClIWEFl~ALM:? OYU 01\10
1tl F ~ y DNOI'ICfJD ORAMIiIIJl1.ED. l"ROVlOl! THS. FOU.OWlNG INFORMATION 20. IF I'FlEVIOlJ!ILVOI\/ClACEl) OR AtNllED. PAO\IlOE THE.~ ~TIOOt
. Dot.Tf. OF CIlCI'lllIE .. I'VICE $1il.lSl .... ~ WI10M 1)I\.'f! Of'DI!CIe! l'Va. ~ ~ WMClM
lUONTH.Dot.\", ~ p:tYa:JllIIITV. STIllEiCOlJlio'mt'. F NOtl.&\l SEl.I' IlIPCIUllE (IIIION'1l'f. DAY, ~ lOlTI'A:XlUI'm'. ~. .. Jl(R' UIII\; Sf.V ~
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1ST
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July 25, 2011
Town of Wappinger
Chris Masterson, Town Clerk
20 Middlebush Road
Wappingers Falls, NY 12590
RE: Certified Copy of Marriage License
Dear Mr. Masterson:
Please send me a certified copy of my marriage license so that I can update my maiden name to my
husband's name with the Social Security Administration. I have enclosed the Application to Town/City
Clerk for Copy of Marriage Record and the $10 fee. For your convenience, I have included a copy of my
marriage license.
Please send to:
Simone De Carlo Cahill
648 E. 7th Street, apt.3
Boston, MA 02127
If you should have any questions or need additional information, please contact me at 617-913-4001.
Thank you.
Best regards,
c;~~{flkl't(
Simone De Carlo Cahill
Encl. 3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Col!)' of Marriaqe Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
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.
_V'/.-.....*..<-<<~<-u..-..~..'(,. ...... ::"~~.~::: ;<;;:(.%<<......:<<......<<......%,r....-.u ..../ 'Z......~.r <::: . ," ~... "?'\ ~"I'X~',::" ~..... Y.~...............:;../..z...:<<..:i:~~)o~.>>.~~..-:~_
tiRttJ.i4.&,1~~:~~;;~Li1::;J:: : . ::~: ,i:': .... ;:~~~ ::~~ ~':" .:~;,,,~.,~:~:; .~{~:>L;~.~,:. .:>;~.:L :;:;Z,..;fi;~;,iilif@wNtt#ilfiWAk.
Iv
Name (Middle)
of
Booe ~
Bride's Age
or Date of
Birth
Residence (County)
of
Bride t( f ~~ ,
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
5C(1~t/'
(Middle)
A
(State)
t\1
For what purpose is information required?
What is your relationship to person whose record is requested?
If self, state "self.. .
In what ~e y; acting?
~
If attorney: Name and relationship of your client to persons
who8e marriage record is required.
027 I
Please print name and address where record is to be sent
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification. an abslract from the marriage record issued
under the seal of the Health Depar1m8nt. inclUdes the names of
the contracting parties. their residence at the time the license
was issued as well as date and place of bir1h of the bride a1d
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
r:vt Fee $10.00
l.6I per copy
A CertiIied Tnnscript includeS aI of the items of information
oc:curri1g on the original record of the marriage.
SeIRh a1d
Certified Copy
A Certified Tr-.1SCJript may be needed where proof of
..... and certain other detailed inform8Iion may be
required such as: panpor1B. vetenwI's benefiIs. court
proceeding8. or eetIIement of an estBI8.
~~ ,'~/,::'"Z",,>'~::;:,'~,:" :" , ' :' :< .~.. . ' . ' '. ~< ' , \~~X
(Midde) (Last)
V\bJJ
Co\ d.-lo \ 0
V\o.,m..L (y\
In what capacity are you acting?
Name (First)
of
Bride
Bride's .
orOldeaf
Birth
Reeidsnce
of
Bride
If Bride PnMol.BIy
Mmied. S1IIIe Name
U8ed at That Tme
Place WheJe
~Was ~l~J)
(Stale)
-N
s~\f
If aIIom8y. NM1e and reI8Iionship of yaw client to persons
whose n_t. record is requAd.
;?L. ~ lllOO . 4-'11'311 I
Address of Applicant . PIe8Be prine name a1d add! ess where record is to be senl
IQllo l1-h st, (\JvJ(~)1 'A-\\\S~ ~~V\(M)
{ftMShlr-yl-~, ~ ~ODJ \q\~V\;~",,^ sr-. )~tlio~6
OO~1 ~.atnct of Columbia: SS ' .'
TU6scribed and Swom to before ~SE SEE REVERSE SIDE)
I. ~ daYOf~t~
"-
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1t~9
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CoeY of Marriage Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health 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.
rvr Fee$10.oo
~ 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 esta1e.
'f~_o;",,,,,,,,,,,,::x:"'"/,-;Z''''' ..z....~~:>{: . .,....6-~,r.,.. . ,;.x.... ... v........ .....w:,. ....... ({-.-. 'Y....... "%=.. -. v"'... ":" ../.:}%...... ,,/...x ...-;. ......-~-;..(....,. ..y.~~-:x...::;::::..... ...:%~*.~_
~ J41<i;;;d;~~i;;;0f,b~~~~.:L:.~,;/~{:,~;':::;;:;:' <. .:~i~;/ : ...;, :.<, .', .,.'. .~; "\;~~. ,.;: >i. ~;~"::..~'..:.~ :;::,. ,.:...;;.~'~';;;.~%$;@Y:i:~%J{IY.l1;t*~
(Middle)
(Last)
(State)
For what purpose is information required?
paJf (Jolt'
I
In what capacity are you acting?
Name
of
Bride
Bride's Age
or Da1e of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was [)J /I
Performed <A...
(Middle)
l
,...ernt)
t: }; b -
tJl J C( J J qgS-
(County)
(State)
\/\/hat is your relationship to P!I'Son whose record is requested?
If eeIf, state -eelf.- \' (f
_I!.
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Addr of Applicant
A 0 rJ.f-LYl A V ~ n cAe
NQw it. /NY 1255D
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
0,
\
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~
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issUed as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
(Las~
(State)
~~.--~
In what capacity are you acting?
Application to Town/City Clerk
for Co of Marria e Record
X 2... rl Fee $10.00
. ~ per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
SeBn:h 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.
Name (Fm) (Middle)
f II 1"1
~ride UA t1A.
Bride's Age
or Date of n r--.
Birth (/V
Residence (County)
:ride , u-k.~J
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was '
Performed
s
(State)
NY
What is your relationship to person whose record is requested?
If self. state -self.-
H
If attorney: Name and relationship of your client to persons
whose marriage record is required.
t..( D
DOH-S01 (3/93)
(PLEASE SEE REVERSE SIDE)
;:J
f
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records section
Application to Town/City Clerk
for Co of Marria e Record
search and
Certification
O Fee $10.00
per copy
A Certification. an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residenCe at the time the license
was issued as well as date and place of birth of the bride and
groom.
search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
(State)
~
Name
of
Bride
Bride's Age
or Date of
Birth
Residence (County)
:ride Dv /Ju
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(FlT'St)
4)/'4.
(Middle)
(Last)
~/t/
PLEASE PRINT OR "TYPE
Name (First)
~room Z~
Groom's Age
or Date of
Birth
Residence
of 0 J J
Groom ~~/J
Date of Marriage 00
or Period Covered 07 f' /0
Search
Place Where
ucense Was
Issued
(Middle) (Last)
C ~ /!/
2C
2(p
(County)
(State)
~f
1'0<- P"'l""'" is ~ required? ,1
/:;j~..v I- s: S . (~
(
What is your relations~ to .~n whose record is requested?
If self. state "seIf.- P ij
=
If attorney: Name and relationship of your client to persons
whoSe marriage record is required.
In what capacity ~ you acting?
~;r
:;J
Date ,..../ .
6'/.2..6: 1/
Please print name and address where record is to be senl
;? {u (r/~/t/
OOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
y
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certification
d Fee $10.00
l:J 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
eertifiedCopy
O Fee $10.00
per copy
A Certified Transcript includes all of the items of intormation
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 benefi1s. court
proceedings. or semement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (FIrSt) (Middle) (Last)
of ~ ~10- ~au\. c:Jos>- of Ko. t\~ OJet ~eill
Groom Bride "V'"\
Groom's Age 002{o )"/8 \ Bride's Age
or Date of or Date of CJ2> o<l S
Birth Birth
Residence (County) (State) Residence (County) (State)
of \ 'K~-eS> !/VI of \ i
Groom Bride ~..y\--cJ.'\S'<;
Date of Marriage If Bride Previously
or Period Covered o '-( /;1 () DB Married. State Name
Search Used at That Time
Place Where Place Where
Ucense Was Marriage Was
Issued Performed
For what purpose is information required?
L-o~-t- Or ~ CS ,,0.'
What is your relationship to person whose record is requested?
If self, state "seIf.- Se i ~
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date
Signature of Applicant ~
Address of A lieant
~~ 0 \6 'Yes-\- ~
Ka.rL~-('C>) VI \a 5'1 ~
DOH-301 (3/93)
(PLEASE SEE REVERSE SID
AUG 1 9 (011
TOWN OF WAPPINGER
TOWN CLERK
,
Appucat\On to Town/City Clerk
tor CO ot Marria e Record
-
search and
~
O Fee$10.oo
per copy
,,~... ~ froIl\ "'" __~ loolJOlI
..- ""'..... "'''''' HeoIIh ~...,... "",-'"
\110 ~ perIleS. ..... .......... 8l""'- "",-
_ ...,..0 as.... as_.,d ~"'- ",..._.,d
groom.
^ ()efIiIic8Iioll- be IJllOC! as prod1bBl a ----.
semch and
certified COPY
~Fee$10.00
UJ ~r copy
"eartified Tnonocril>' ~.. "'\110'" "'~
()CC\J'ring on \he origin81 record ot 1he marr\8Q8.
,,(;aIIiliod T.....,npt _ be.-lOd _....... 01
~ancI"""'*'-dollIilO"-- - be
~suchas: ~ ___'8....-.""""
pI~t or ae\lemtdotan--.
~ "'""" (FlnIO (IAidlI8l
_ ce-;; ~ futh lcen f\J I
Bride's Age
orOateof
Bir\tl
fleSid8nC8
of
Bride
If Bride PfeviouslY
Married. State Name
Used at 'That Tune
SQ()~
[)OH-S01 (Sj9S)
(PLEASE SEE REVERSE SIDE)
-
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i
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i1 WI ~o H:;AJI (de (0r 0-6 nJ l'ems"0Pdk- --t1J~
n cL (YIe 05- ---ti1e (J)luJYJA I tt LL5 b;;J IS n~
-Sl)(t~L &1 Peo-C-e-, \ll~ mai&w- rt(JJYiQ.:
~leeJ\ n, f\bbCl-S, [nCd()3e~ IS $/O,lV ~i
~~~~~ ~
I 00 \ WW I ~ te fi~a.C-12- \ -3,5 9:-~S ~ 31 ;;2J
L.
\J8J,J beW'Ltj- ) P L-- :3J-GGq -?-7::2.. q
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aL/L,(!JUlt~ II f 1fC3!WY-
~JP/I
..... ANGELA JOHNSON
. Notary PutI!lc . Statl of Florida
. My comm. Explr.. Jun 14. 2014
Comm\lliOll # EE 341
...... ,......1IIIIDMI1IIlIIIY
"
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriaqe Record
Search and
Certification
rt7f: Fee $10.00
UA..I per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Depar1ment, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
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.
~_iWJ!::[;;&;~~:~lli;:~2:::'~:;:.r::>:;~~:;::.~:.t~:'~~.:.~::r'.:'v~ :' ':'..':.~,~~:.~>: ':'~':.:;r~f: ~;::.::.:::':::..::':::~~':::~:.:~i,liiB'!11~IZ-
Fo~~nrequired?
What is your relationship to person whose record is requested?
Ifself,state-self.- ~
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
/0( ~o3
1~a3
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
"
#JS
y/ I (, (1% 7
r
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records section
o Town/City Clerk
f Marria e Record
A Certification. an abstract from the marriage reco
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.
For_~i5.:55~7-t-
'MMlt is your relationship to pers.on whose record is requested?
If88lf,state"8elf.- 5p I -f
In what capacity are you acting?t f
. 5.e
If attorney: Name and relationship of your client to persons
whoee marriage record is required.
60l+ W;tyO
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
.
J
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
tor Co ot Marria e Record
Search and
Certification
O Fee$10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A CertIfied Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
(Middle)
\2.
(Middle)
e\:5
3
(County)
(State)
(State)
~
For what purpose is information required?
-\-(') ~* \=~ c:\ <;: \'J~ Q \ (.. ~ ~
~..,.."e..~
In what capacity are you acting?
V\Ihat is your relationship to person whose record is requested?
If self, state "seIf.- S~
\
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Address of Applicant ('\ .
-3 \.\S~ S ~~-\Q.. '-.N'>&
5e..~ c ~~~) \= ~ -.3?> ~ 111
address where record is to be sent
DOH-301 (3/93)
(PLEASE SeE REVERSE SIDE)
A CERTIFIED TRANSCRIPT FROM THE REGISTER OF BIRTHS
DISTil'
1302
LOC';L #
588
PLACE OF BlRTH City of poughkeepsie
NAME
PATRICIA ANNE TILLIETS
SEX
female
DATE OF BIRTH
June 7, 1947
FILING DATE
June 11, 1947
I hereby Solemnly Attest, That this is a true TranscriJJt from the Register of
Births as kept in the City of poughkeepsie, Count~' of Dutchess, State of New York.
Dated at poughkeepsie, New York.
the
16th day of June
1 Cj 89
, -
eputy
t\
.......... 8~=
~.- fheSullsldfle St<Ue -~--
"325-681-47-707-0'
cuss: E
SAFE ilJ1\llli
<11.' Sh,J~.~I..~,
\
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certification
O Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties. their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcript includes all of the itemS of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings. or setttement of an estate.
(Middle)
Name (Fnt)
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married, State Name
Used at That TIfJle
Place Where
Marriage w.
Performed
(Middle)
Fcr_purpooeis -~
---tD rQ CUv{) liDYCR
d~ QfO-'J
In what capacity are you acting?
V\Ihat is your relationship to person whose record is requested?
If self. state "seIf.- 5 e..i .p
If attorney: Name and relationship of your client to persons
whose marriage record is required.
tobe l
Address of APPlican.t 1'",_, l.... ~ A
(Y)ej\SS[LwLlXA r
&bQ l.C0Ill:S.$~~ ,\
, -Rv.1s J /)fjetu
SEP 06 2011
R
DOH-301 (S{9S)
(PLEASESEEREVERSE IDE) TOWN CLERK
~
J
,
_10 .
"
NEW YORK STATE DEPARTMENT OF HEALTH
"ital Records Section
~.,o.oo
lli ;;:.. wpy
A Certificalian, an abstract from the IlUM"riage rec;ord Isaued
under the seal of the Heahh Department. includes the nM18S of
the contracting parties, thei" reU:Ience al1he time the license
was issUed as M1las.datB md place d bi1h c11he bride and
groom.
^ Certific8lion may be used as proof that a marriage occurred.
o F :;YOO
A Cer1ifiecI TraIIl&CI ipt - &II of 1h8 ilerns of r.formation
C'.lCCUI'1'ing on the original r of lie marriage.
A .CerIiIied Transcript n.1"Y be needed where pr of
JWC!"1age and certain ott;er detailed ~rmation. be
l'BqUired ~ as: ~. veterBn a benefits,
pnx:sedings, or &elllej of an estate. i
( bile)
W3
00H-301 (3/1J3) I :s- .
. . (PLEASE SEE REVERSE SIO'i
~,~t1.4~ ~/I~'
Z:0/Z:0 3Si\;jd
H3T10~ldwm
08/24/2011 14:03 FAX 5187927497
'I,
...
STAPLES
.
14I 003
~
...
...
...
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Co of Marria e Record
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 resicJence 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
proceeclings, or set1lement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (Fm) (Middle) (Last)
of -r~ON. S. . of K~\ S~ 1M. I
Groom Lc~~' Bride
Groom's Age 5J~~"~~!J Bride's Age LI/s/J q {'l,
or Date of or Date of
Birth Birth
Residence (County) (State) Residence (County) (State)
of 'O.......+-c..he&.s tJ\f of 'D t.(. ./-~ s ~ N'f
Groom Bride
Date of Marriage ~J~IIJ If Bride Previously
or Period Covered Married, State Name Selt ,~( I'~
b Search Used at That Time
Place V\lhere N...lf~ J N'f Place Where
Ucense Was Marriage Was
Issued Performed
For what purpose is information required?
6 h<..lt. ((. (1 Lo Pf
What is your relationship to ~rson whose record is requested?
If self. state "seIf.- $c.( ~
In What capacity are you acting?
S'~tf
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date
q 1,111
Please print name and address where record is to be sent
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
J
v
cr"
\
-C.
~
--t:.
.-.
-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Col!)' of Marriage Record
Search and
Certification
O Fee$10.oo
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Depar1ment, includes the names of
the contracting parties, their resicIence at the time the license
was issued as \\'811 as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Se8'ch 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 setIIement of an estate.
'"~,~y~~~~' .'~,;,r':'~: ..' ,"' . " " .."::::>'" ",. " 'Af ":,?\W.,{
M':::~ ..,.~~. .>>,,'~.' .- . //... .-/, X ~<<h<<:%. ~
PLEASE PRINT OR TYPE
Name (First)
~oom M Ic~oe ,
Groom's Age
or Date of -'/?OI4 q
Birth ~
Residence (County)
~ -:Put c:h-tsS
Date of Marriage
or Period Covered
Search
Place Where
=was VJrApp I h
(Middle)
1)
(Last)
}\e( f\ V'V"l a h
(Slate)
tV '1
6-3,/c/7Q
r;;J'
In what capacity are you acting?
Name (First) (Middle)
:ride Les II
Bride's Age
.::-of /llzz/s-v
Residence (County)
:ride Dk~""s~
If Bride P~
M.ned, State Name
lJaed at That Tme
Place Where
Marriage WB/8 Le Vi fI 0 U/ V\
Per10nned '
(LB/8t)
l?> f> r l( €
(State)
\'.1'1
What is your reI8tionship to person whoee record is requested?
If 88If, staIB "aeIf.-
If attorney: N and relationship of your client to persons
whole marriage record is required.
I Wood/oJ-vi lJr
;tip u.J 'leU fr !lJ11 ( SZ/
00H-301 (3/93)
Date
0, 3/- I
Please print name and address where record is to be senl
(PLEASE SEE REVERSE SIDE)
J
~
~
<a-...... ~.
,
w W
"--
~
--(',
..
City of poughkeepsie, New York
Office of Vital Statistics
62 Civic Center Plz, 1st Floor, P.O. Box 300
poughkeepsie, NY 12602
(845) 451-4203, 8:30 a.m. to 4:00 p.m., Mon. - Fri.
J#70
~,;}Yi)
Aoolication for Transcriot of Marriaae Record
$10 FEE REQUIRED FOR EACH TRANSCRIPT REQUESTED, PAYABLE BY
CASH, MONEY ORDER, CERTIFIED CHECK, OR VISAlMASTERCARD.
WE DO NOT ACCEPT PERSONAL CHECKS.
--:- -
Name of Groom: \//r,///,ES VO~
Maiden Name of Bride: "/ ~ '-/ 677~S
b'r)--f.8:5
# of transcripts requested: _ /
Place of Marriage: N~~~~ d~
...a . ~ /
Purpose of Request: e;/'J~/,y ~;17
How are you related to Bride/Groom?: :5~
--- ---
Name of Applicant: ~6!5 ~
Add ressJp hone/sS#: ~ _ ,?~~~d?.1J%56~J
Date of Marriage:
OFFICE USE ONLY:
10 RECEIVED:
Dist. 1302. Reg. #:
# of copies:
Issuing Agent:
q\\\"\\\_ JvY\ ~lh\
~/a.olll - 4/11 Jrm
q /a:) ~.- t/ )YJ Ivtn
Sox:>
dtJd. aO"7'" 7foo
. ....................i..q_..".
. ,,'.....,..-...--.'..-.-.-...
Application to Town/City Clerk
for Co of Marria e Record
r\':'_lll:.I_\_il[it~i;~j;"""."""" ............:?Ni/....
Search and
Certified Copy
O Fee $10.00
per copy
A Certified Transcnpt includes all of the Items of mformation
occurnng on the origmal record of the marnage.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Search and
Certification
Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, Includes the names of
\ the conlracllng parties, their residence at the time the license
! was Issued as well as date and place of birth of the bride and
I groom.
I
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.
. - ."'. ,"' ....... ,.q ...... ..... . ... ... " ", .--" .. --'" " .. .... ." . ...
....:...........ft....I2S......gJi!f::~ADftl::E..irE.....:..:t!i~M.....:....:..ii'ln::neM.....'I+..........F........E...S....
'. - ->:;:r:. ~:',_,.:::_::-::.:~:-.::.J,:;{~:~E:~...::::~~!:_~~-:";~:~:~~"n;_:-;.:-_:-:r~~:~~"P..:-,-:,!J:?:::-.~.:.. .. .... .'..'.-., .
(Middle) (Last)
( -A'~/~
" /' \..7 C-.Y'L t;;... ,,:)
( First)
(Middle)
(Last)
..577 L-G:.
3'~7/bS
(State)
(County)
(State)
N~
I For what purpose is information reqUired?
I / /~ . ~ .
~ A- C}~P7 ~Fa/~~
U~
What is your relationship to person whose record is requested?
If self, state .self.. . 2~
......................--- I
!
in what capacity are you actmg?
_..~.....--.........._.-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
~/3.~//
Addr pplicant
/.?b'/9 ~ ~ ~6'S Ld-
1/4/~ ~, 6S--6<L /
Please pnnt name and address where record is to be sent
~~S V~~
/36 ~~.5##~w ;?~W
Y-
DOH.301 (3/93)
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CoeY of Marriage Record
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.
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 setllement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last)
~room Chn!S \)w} K~QS .l~~
Groom's Age
~~ateof IV USr Lf /97/
Residence (County) (State)
~room 31 S H 1{Z; Cv \'1..t y$' ~. W
Date of Marriage r!'I r
or Period Covered ~ cH
b Search
Place Where
Ucense Was ~
Issued
For what purpose is information required? (10. )')f(,V
Ch~} V\hlv<- ~ Pvr Wovk--
, ~N ~ ' rn.{b
In what capacity are you acting?
Name (Middle)
of
Bride
Bride's Age
or Date of
Birth
Residence (County)
fCt{\of
Bride \)~ks
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(State)
10:/.
What is your relationship to person whose record is requested?
If self, state -self.-
S::Wk
If attorney: Name and relationship of your client to persons
whose marriage record is required.
~.;I!.ft;=f.*0:~}~&;~;::::;ii::~~:;t).i:~. . ".;. '.'~ .~~~ i '. .'.. .:\. >~na(::~;<~. ~:.> ::':;~i~S;~1kt;;tt~'.!;._
SignaturY;'Qicant ~0.1!
Address of Applicant
,
k~
DOH-301 (3/93)
Date
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
-
-
Application to Town/City Clerk
for toe}' of Marriage Record
Se~hand 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.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of MarriaQe Record
Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
O Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed whera proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or setllement of an estate.
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last)
~room Cb( S \),.;} K ~ OS '( \\. C\
Groom's Age .
~~:;'ate of IV USr Lf. 19 7 I
Residence (State)
~ rd.t,J
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(State)
10-'1.
Name (Middle)
of
Bride
Bride's Age
or Date of
Birth
Residence (County)
~of
Bride j)~ks
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
For what purpose is information required? (10. ))fO/
Ch~} ~h Iv<- rov... Pvr Wovt--
rva...N ~ ' ~fb
What is your relationship to person whose record is requested?
If self, stale -self. - .
s::4~
In what capacity are you acting?
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signatury;:'a.icant ~
Address of Applicant
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 Marria~e Record
Search and
Certification
Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
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: passpor1s, veteran's benefits, court
proceedings, or setllement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of t _
Groom L-O Vt I
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Middle)
(Last)
..5~L-- Z-
(County)
~ L&J/4.,
(State)
For what pu~ is information required?
~'t
->--j
In what capacity are you acting?
Name
of
Bride
Bride's Age
or Date of
Birth ~ ?,)- 'SJ
Residence (County)
ofride f t:, L I'J-.IlI A
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(First)
'-f}J /11L:
(Middle)
~,
(Last)
tJ JH..~frAJ 0
(State)
4A., ~Ls.. . ttf/
~~/~~
What is your relationship to person whose record is requested?
If setf, state -self.- -
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
/ Po. ,1,;1.
Please print name and address where record is to be sent
[R1~CC~~~~[Q)
JAN 2 0 2012
TOWN OF WAPPINGER
TOWN CLERK
(PLEASE SEE REVERSE SIDE)
...
J
-'-
,~
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
tor Coey ot Marriage Record
~/:. i.:'_:;,.:jiif~i2."(~"" ..".: >~\>,' , , '" >:'. ,,"': ;c"'::;{.;,;ii:
== D Fee$10.00
per copy
A Certification, an absIract from the marriage record issued
under the seal of the Health [)epar1ment, 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.
s..ch and
Certified Copy
I'Vl Fee $10.00
~ per copy
A Certified Transcript includes aU of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
.-entage and certain other detailed information may be
requi'ed such as: passports, vetera1's benefiI8, court
proceedings, or settlement of ... estate.
~~ ~\.:-....\. ,~ ....'"J'~.. .." '\.::~'^ ~
.;..~ <x~. .:xdx: ~ <" ::x..... .. .. >>> :ri~"
~'<. /' .':;.... ,< . ,}, " ',' " , .,....:,.:
PLEASE PRINT OR TYPE
Name (First)
:room E i"" '\c...
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
· by Search
Place Where
=Was lo'\\>n 0", \\)~"'f\.~er
(Middle)
No\~
(Last)
80.1 qc.u:Ju
, 1\ '5/ \C\ ~ l..
(County)
M tMle~"
(State)
MPt
~I1J/wt1-
For what purpose is information required?
-JD'"" Y1Ct.iYlL en. a..ng<: wi"fi, Soc..tOJ
~f}j
In what capacity are you acting?
Self /oooe-
Name (Firat) (Middle) (Last)
~ T\'\A rio Low~ be\) r\ e ~
Bride'sAge
:.a,Dateof S/llJl/\q ~3
Residence (County)
~ H \OdJese)C
If Bride Previously
M..ned, State Name
Uaed at That Tme
Place Where
~:Was HD~\\ ~ct
(State)
NA
n/o....
Whet is your r8I8IioIl8hip 10 person whose record is requested?
If self, stale "self.. .
self
If attorney: N8ne and relationship of your client to persons
whose nwri8ge record is required.
S
;.:. ", ".,;:" ., , . . .. .)1.~1
Date
~-----
DOH-301 (3/93)
l b \II J 1.0 \1.-
Please print name and address where record is 10 be senl
T~ rid ~\trie~
\ \'\h \\ow ~"'" ~'L
Be\m.O'fl-\, H~ 01..4T~
c.:, l:
(PLEASE SEE REVERSE SIDE)
JAN 1 9 20\
,
TOWN OF WftP~~:
Tn\NI\I CU"
'l&
.
f/':!':'~ t. 'l-"ll~ 'r.2jCl io""p"'AjnqAll'
.... \;.. , - t"l:S8aI"cn\alid""" n
. '~"1l~gof..i 'I~Jjyt.':)t~(l
per copy
;A~aiiinJ~~1B~m fi''riWriqge.r~tQ iMuml
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.
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
~~~~~-_:::~~-_.,_:) .
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
D Fee $10.00
per copy
.~_~r!!!!e!:t~pt includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of .~
Groom \...:) \, \J \ ~
Groom's Age
or Date of
Birth
Residence
of
Groom
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was_
Issued \
(Middle)
(Last)
) -. '>(\tjt..->
~,
(State)
UY'
For what purpose is information required?
r ATIDL l~ '6 U[~S I~, ?iZce L C;; S
In what capacity are you acting?
~u:-
Name (First) (Middle)
of
Bride
Bride's Age
or Date of
Birth
Residence (County)
of
Bride
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Last)
(State)
What is your relationship to person whose record is requested?
If self, state "seIf.- '
If attorney: Name and relationship of your client to persons
whose marriage record is required.
HIlL
'C)(_:(, rt\l(C-c v'S I t. ~ ~ y
DOH-301 (3/93)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Col!)' of Marriage Record
_;H1~~~Ilftifl~~~iTwt~:~~1~:~ ~~~~"'~::~~~-:<'."", /~:~~"'. ~<:~:\ ~.;; ~~ .~..: "':::~~>~?l\~(:r.tI~~~f.:/~:f;~f~t$fihBt.I'_
~~{~~J$@m.@~.>>::.....~.<'...::...>>::..:::~y.:::::...:::;;}.:...~.~..I':- .....::.-:::. <:..... ..... ~ .. ......x:..x.::.:...{......;.;.:....-;;..'"v...'<::(:%:=*-..:::.~u&<..{.;:::--=*'~~::.w:~:Jkii:.~ ~-:::..-{..i~
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefi1s, court
proceedings, or setlJement of an estate.
_@YN..:::::.......~.....N;::.;.4>>....~~..<.~v>>....<<::>>.. v:v.""<"%~"'''' .x."~X::'" ..... ..~...>> ........x.."..... ..;.;....~. .... .<<..<......m:<...-.-yw~*..::::..<_
~f4ii@tllrZk~tlt.~:~.<~~:.:~;i~:<;~;~:: ~:.~~~;~~ ::: ,: ~> .~~^ .~.:~~.~. .~..~:.~~.'~:~ f:~~~..:~>~ ::j$~~~~.:~~~~;~ .:..~.:.~/.j~;J.x.~~kMrM$WtE%1*tt
(Middle)
H
(Last)
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride
If Bride Previously
Married. State Name
Used at That Tune
Place Where
Marriage Was
Performed
(Middle)
(Last)
(State)
(State)
(
For what pu~ is information required?
f(3)f a 'CC7,
What is your relationship to person whose record is requested?
. If self, state "8eIf.. .
<-e f-f-
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)
;
~
..............
'-
~ ~
::.......
~J ..............
~.,.. --
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CoeY of Marria~e Record
Search and
Certification
D Fee $10.00
per copy
A Certification. an abstract from the marriage record issued
under the seal of the Health Department. includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or setttement of an estate.
(Middle)
':::>
(State)
W'--
For what purpose is information required?
C()J~
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
Piece Where
Marriage Was
Performed
(State)
(First)
(Last)
, " \ \tJ,~
/C?y- dd- ~-\<G
(County)
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.
(3)'Sj t -Vl:7\-~ \A0 ~
v..)C\~~ V' c~ r~ -\~ c.. \ \ ~
DOH-301 (3/93)
- \ \
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
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: passpor1s, veteran's benefits, court
proceedings, or settlement of an estate.
PLEASE PRINT OR TYPE
Name (First)
~room ~O~bE-
Groom's Age
or Date of
Birth
Residence
of
Groom bu TC. H-E5 J
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Middle)
P/Nl-
(Last)
P,4lC.H-O ~o5
11/9/7(P
(County)
(State)
/0,/
J () J 3/ / iI
Name
of
Bride
Bride's Age
or Date of
Birth
Residence
of
Bride J)\lTC.l-\f S J
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(First)
(Middle)
(Last)
~v tvr..hN () Ii A M
EAtV
3/lttJllf
(County)
(State)
N
6<l~6ItfSf.
VILLA
For what purpose is information required?
[1ilt''N.t*liilf~Y'~^>>~@~-::@>>~':::::''Y' '''.w.:w.:::;::-&'lliW'&~.:;:":.,,,........, '. ""'x w . d:'V C ~..,. .... c. "" ..., x.. . . .V".,y.:. .x...,/.,." "Xv"%: ^::>.~%::m:y"'w:':,>>~"':0W'X^<<~~~^,,x'::;r.r,;::::xw-::::'Yi(mt~
What is your relationship to person whose record is requested?
If setf, state -self. - ;5 E ~ t=-
In what capacity are you acting?
:SELf
If attorney: Name and relationship of your client to persons
whose marriage record is required.
i~l]tf:MW~~~~':::X<<"'~':}>>::-";'N..:.:.....-:X'''':~/.-:'M*-~:>-'''-:-:':-':';.;.......:...;...;.....<v;..... -:.......x " ... <-: vv. ..: . -:... : .... <:...<...:...:~~......<<...:.:.....<.. .... w...<.........:...:...:v>........::::>~~~...:<<~h~~:mr*..X;~
Date
Addr fA lieant
'3 ') lfuc ~ S L4N€.
/-foP E WE'lL ..) c, t'-1'1 I ~ S"' 3 3
DOH-301 (3/93)
,/ ~ I (~
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CoeY of Marriage Record
_~~{@~r~rtJtti.I~t~~~~~:~}:l~~~~~:'~~: :? ~~~ ~.. d.~. r: .~ :~?1':~ . ..:~~ .~:.: '~+~\r(;;'?;:::/:)~/)r~~~~~:~1fu?Wi_
:t..x:~~.m@::~'::-@{:?3:~.::::Y..""'w",~'::%::..X<X..........::- .):.*<>:", ," ....{ ..v.:,r. . ^.....~...:~:%:...x.........;:r..-:-.~.../. .:>."*....:-.>:..... .;~h:.M.".,;::.:m<~~.;;m~~.-=:$;.~~
Search and D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Depar1ment, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certification may be used as proof that a marriage occurred.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefi1s, court
proceedings, or setllement of an estate.
_.'Wimm"'...'^...."NN.W~,~"."."'....... ,.z.... ,..,"N'"'''''''' .,.", ".... ^', ' ,,'~ ""'-<:iv' .."w."."......,.<..z.F"~f:;1...'m::::"__H
tsj~fufri0;~~~i~~iTi~~;;~::~.~::~.:.~:t~::~~;.:~ ~. .~...1;:( ;:~: E :~::~:: . . 'd>~~~ .~....~.~~x~.~..~.:~4;:J~~~:~:: .~ .~::~;~~ ~~.:.~;:~;(~~,~~'jg_fff?;1;~i~~ 1..
PLEASE PRINT OR TYPE
Name (First) (Middle) (Last) Name (Fnt) (Middle) (Last)
of ~ I 'II"" (lG'>f'IS~ I of M
Groom JeS Bride
Groom's Age Bride's Age
or Date of ; - I '1 - /1&fo or Date of \-
Birth Birth
Residence (County) (Slate) Residence
of b.A.cksS /J'f of
Groom Bride
Date of Marriage q!/p/.(eJl/ If Bride Previously
or Period Covered Married, State Name
b Search Used at That Time
Place Where Place Where
Ucense Was Marriage Was
Issued Performed
For what purpose is information required?
S ~(I.J )f'CV r/fy
~
What is your relationship to E!'rson whose record is requested?
If self, state "seIf.- ~J s;l
In what capacity are you acting?
5~ ( .c
If attorney: Name and relationship of your client to persons
whose lMrriage record is required.
address where record is to be sent
fJV lZ<;f! 0
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
~~~~~W~[Q)
DEC' 22 2011
TOWN OF WAPPINGER
TOWN CLERK
J
..
(R1~~~~~~{Q)
DEe 2 2 20\\
TOWN OF WAPPINGER
TOWN CLERK
~T.-\ TF ()f NOR111 CL..'tROlIN~'~
. ~ ~:,
BEt
~ i L ,L,'tr DRIVEFI UCEr..3F 25272'504
~"-~--"""'''~,":;;
\
MICHAEL LAWRENCE MATlJSIE
816RED oAK TREE DR
FUQUA'{ VARINA He 27526- 496ll
c!a~,sC endolsNone 'ssrrNone
i3$UA(! 02.?6-2flrnl ~'~;r.'> '1-"o..?:i1S ->',
~ '~2'~ ~, --<1 '".> j-...',L ;=-l.i~i
blrthdale
11-30-1972
~~fr:~~' ~2
=-~~-=~[~~--h _^~A...f_~~.
.....-..............~B-..-~-~_.~ca:6 .~~_.___._......_._
- . _ ..--.-&lic6a.eL-L_~.<; ~J -k'52 __....___.....__..___.__._
. . --.--_.:S-1.LC~~..M. Ch.a_s1: av, CJ D.n-..._.___
..-.--.-...---..--3.1 ~ll ~.L0t.~ u:k ~-+. &ihtnDe11ae..L_
..~h.lU'c.kuL"'J. .~.. .. +O~~:Lo.J-J?..Q~b~~/.:A.;'~-II-J\)
po - ~ J h
...__._._.._._--~~ )~~_.- ----.----..-..-.-.-.-..--.---.-..----..-..........
-.--..-.----....---- ~ \ 6 ,\<.e&.. On 1c. -=UA..~ '"Dv i ,,~___.___.._.
---.__..._______\7 ~o..~._~ C 2., 7 S 2.J.a._._.____._.
~._-_.._-_._-.._---------------_..-._~_._-----~_._----.'----.-
--~----------------_._-_.,-,._--
.---_=r1--aVlL \f o,.u J _
-----uu____~ /'vl i ~:2tL4t! ;<--___
.. .u......---.-----.-..__ftr' . ?~_.__~
_ AtAta Of 1tL ~ ~
. ~:~~rtify: -
~,t.:Me'c.... L M.A!1"U~It:i- - Personally
8PP'*1ed before me 1his-day and ~~
the due execution of the foregoing.1nstrurneI:1t.
- VVNneSS my hand and seal
this da of
--_._-_._,._._-_....._~.~_._---_.._---~-_._--
-_._----~._--------------.._-_._-----,~-
--.---------------------..---
I!
- - - ---.-.-.-~---.-.___..._.___M_____._..___...______.__._._.______
Notary Public
-Durham County
North Carolina
My Commission Expires Dee 1. 2012
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
-
Se~chand D
Certification Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
A Certification may be used as proof that a marriage occurred.
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
~entage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or setllement of an estate.
PLEASE PRINT OR TYPE
Name (First)
of
Groom
Groom's Age
or Date of
Birth
Residence (County)
~room:;2$ [; 0 w "p,
Date of Marriage
or Period Covered
b Search
Place Where
Ucense Was
Issued
(Last)
'T, t)DLpI\,,J
(State)
(j)fYf/lfJ/btXi> ffJUJ
For what purpose is information required?
}1c1l L rH 111J.>4<. fH'vt ~
In what capacity are you acting?
.s fJ.. (
Name (First) (Middle)
~~ GfI{t1~I,vC 'J.,
Bride's Age
or Date of
Birth
Residence (Cou (State)
:ride f fj'1716"" f tfJct.- WIif/lfVbu:>ftn.~~ 0/
If Bride Previously
Married, State Name
Used at That Time
Place Where
Marriage Was (' f'
Performed ;?'
(Last)
f)6Lt.oT'/o
~)p
What is your relationship to person whose record is requested?
If self, state "self.. '
s.6/.--f
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Date 1 j
j;J/IJ,//rJ j (
fi V c: Please print name and address where record is to be sent
fJI, 1~7P'
DOH-301 (3/93)
(PLEASE SE
DEe 1 5 20il
TOWN OF WAPPINGER
TOWN CLERK
-Of
NEW YORK STATE DEPARTMENT OF HEALTH
Vi1aI Records Section
qtJ~
Application to Town/City Clerk
tor Coer of Marriage Record
Search and
Certification
D Fee$10.00
per copy
A Certification, an abstract from !he marriage record issued
under the seal of !he He8IIh Depar1nl8l'1t. includes !he names of
!he contracting parties, their residence at !he lime the license
was issued as W8II as date and place of birth of !he bride and
groom.
A Certification may be used as proof that a mani8ge oc:amed.
SefKh and
Certified Copy
l'\7( Fee $10.00
~ percopy
A CertiIied Trall8CripI includes aI of !he items of information
occurring on the originaJ record of the marriage.
A Certified TIWl8Cript may be needed where proof of
parentage and cer1ain other detailed infol'matiun may be
required such as: r:asspora, veterwI's benefits, court
proceedings, or setIIement of an esta1e.
", .,(~:~~ ":~.~ '; ~ ' . . ," .". ,.;,'~:}^ <;~:.~':"',::,>~~;l>JI.?
PLEASE PRINT OR TYPE
Name (Fnt) (Middle)
:oom ., Altx.Jer ~Cl.v'td
Groom's Age
~Dateof bOB 10 -11- I qgS
Residence (County)
:oom Orot'l81.
Date of Marriage
or=Covered April 200Q
r:-.= lO(}Jn of
Issued Wo.. F P)
('--I)
(S1ate)
FL
For what pwpoee is information I'8qlDd?
'V1l~~pad-
In what capacity are you acting?
l )e If
Name
of
Bride
Bride's Age
or Dale of
Birth
Residence
of
Bride
If Bride Previously
M..ned, S1ate Name
U8ed at That TIITle
=.~ Villa. 'BovfQes-e-
PerfOrmed \J
(FIl'8t)
1::lore n~
(Middle)
Ho
(last)
t)6B 01 /a 7 /,<1 &4
(County)
o ro. e.
(State)
FL
If atIomey: Name and retationship of your client to persons
whose marriage record is required.
SAM~
:>
D0H-301 (8193)
'S+Q. +e.. 'CA- "Fla., Clb~
CoLA-rltv'v 0-+ On:,v(\ct-' 1_ ~r.. II . 1h I ('
__ ~wtrf\ 10 OA\G~ ~iJbS(:f,bed ~k- me.. th,:) ~l{",. .CfctN 6 t-
0-+0 be r, .':<o.!l ,f::J",\ D or ~ 1-l:2r-e k-vr ~ . , \ .' ~
\).e rsun'\[~ knowh" ~: 'bj-fTonda. -y ~~\ <[ -l w..",-
(PLEASE SEE REVERSE SIDE)
-
--.~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for CoeY of. Marriage Record
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Search and
Certification
D Fee$10.oo
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Depar1ment, inclucles 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
1\/4 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.
(Last) .
cle
For what purpose is information required?
In what capacity are you acting?
(FIl'8t)
(Middle)
6
(Last)
,
ck
Name
of
Bride c:u-.. ~
Bride's Age
or Date of 2 <::z:r"
Birth D
Residence (County)
:ride a .lcte5 )
If Bride Previously
Married, State Name
Used at That Time
Place V\Ihere
Marriage Was
Performed
(State)
/V,.
c
What is your relationship to person whose record is requested?
If self. state "self: (' /'
5C r-
If attorney: Name and relationship of your client to persons
whose marriage record is required.
DOH-301 (3/93)
(PLEASE SEE REVERSE SIDE)
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health Department, includes the names of
the contracting parties, their residence at the time the license
was issued as well as date and place of birth of the bride and
groom.
Search and
Certification
A Certification may be used as proof that a marriage occurred.
Application to Town/City Clerk
for Co of Marria e Record
Search and
Certified Copy
D Fee $10.00
per copy
A Certified Transcript includes all of the items of information
occurring on the original record of the marriage.
A Certified Transcript may be needed where proof of
parentage and certain other detailed information may be
required such as: passports, veteran's benefits, court
proceedings, or settlement of an estate.
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(Middle)
For what purpose is information required?
S t,l f
In what capacity are you acting?
~ ~lf
Name (FIl'St)
of
Bride
Bride's Age
or Date of
Birth
Residence ,
of 4 ~ $ ~11' '2..
Bride P
If Bride
Married, State Name
Used at That Time
Place Where
Marriage Was
Performed
(Middle)
What is your relationship to person whose record is requested?
If self, state "seIf.- ~
If attorney: Name and relationship of your client to persons
whose marriage record is required.
Signature of Applicant
Address of Applicant
DOH-301 (3/93)
Date
Please print name and address where record is to be sent
(PLEASE SEE REVERSE SIDE)
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Application to Town/City Clerk
for Coey of Marriage Record
Search and
Certification
D Fee $10.00
per copy
A Certification, an abstract from the marriage record issued
under the seal of the Health 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 set1lement of an estate.
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(Middle)
(last)
U<2.\ (<AS
(FIrSt)
~Uf/
(Middle)
(Last)
~.
;::) \ C,-_
For what purpose is information required?
Sr~ ~o Y>~ / I, IoD0 ~
\Nhat is your relationship to _".n rson who 088. record.. is requested?
If 88If, state "seIf.- \-\ u <;. DO-)'\.. cL
I
In what C8fllf. ~. '. e you acting?
<::..c \ (t-.
If attorney: Name and relationship of your client to persons
whose marriage record is required.
I OJ,.. f ,11 OU) rf-C4 t,tt
DOH-301 (3/93) I \J . r t.
. s., Lol J, -
/03/.
(PLEASE SEE REVERSE SIDEfF' ~ 2 c-; ,', \l
Jj JA~" 2 1 :~:2 )
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