HomeMy WebLinkAbout03-05-07
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MARRIAGE RECORD
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Appl No. 2007-00102
1. COUNTY ISSUING LICENSE 2a. WHERE MARRIED-CITY, BORO, TOWNSHIP 2b. COUNTY 3. DATE OF MARRIAGE
(Month, Day, Year)
CUMBERLAND
4a. NAME OF PERSON PERFORMING CEREMONY 4b. TITLE 4c. ADDRESS OF PERSON PERFORMING CEREMONY
(Street, City or Town, State, Zip Code)
GROOM BRIDE
5. Full Name MOORE BRAIN DAVID 14. Full Name FOXX SUSAN B
Maiden Surname
6. Mailing Address 30 NORTH 36 STREET APT 1 15. Mailing Address 30 N 36TH STREET
CAMP HILL PA 17011 CAMP HILL PA 17011
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7. Residence: CUMBERLAND 16. Residence: CUMBERLAND
a. State PA b. County a. State PA b. County
c. Location c. Location
(1) City of (1) City of
(2) Borough of (2) Borough of
(3) Township of HAMPDEN (3) Township of HAMPDEN
8. Occupation 17. Occupation DRIVER
STOCKPERSON TRUCK
9. Date of Birth Age roo Birthplace 18. Date of Birth Age 119. Birthplace
5/30/1978 28 SPRINGFIELD MO 12/07/1965 41 PEORIA IL
11 a. Number 111 b. How and When Dissolved 20a. Number 120b. How and When Dissolved
of Prior 0 of Prior 0
Marriages Marriages
12. Cause(s) If Divorced 21. Cause(s) If Divorced
13. Education (0-12) I College (1-4 or 5+) 22. Education (0-12) I College (1-4 or 5+)
I 1 03
12 I 01 12 I
Date License Issued (Month, Day, Year) I~ate Report Sent (Month, Day, Year) I Signature of Clerk
To Vital Statistics:
Given and Surname of Father Given and Surname of Father
MOORE JAMES M MOORE MICHAEL A
Given and Surname of Mother Given and Surname of Mother
MOORE ANITA L MATTERN ELEANOR M
aiden Name of Mother Maiden Name of Mother
HENRY RIES
Residence of Father Residence of Father
DETRO! T MI DECEASED
Residence of Mother Residence of Mother
DETROIT MI WENONA IL
Occupation of Father Occupation of Father
MANAGER DECEASED
Occupation of Mother Occupation of Mother
HOMEMAKER BOOKKEEPER
Birthplace of Father Birthplace of Father
WENONA IL
Birthplace of Mother Birthplace of Mother
LACOM IL
Is applicant afflicted with any transmissible disease? Is applicant afflicted with any transmissible disease?
No No
Is applicant now under the influence of any intoxicating Is applicant now under the influence of any intoxicating
liquor or narcotic drug? No liquor or narcotic drug? No
Relationship of parties making this application, if any.
NONE
We, the undersigned, in accordance with the statements hereinabove contained, the facts set forth wherein we and each of us do solemnly
.swear are true and correct to the best of our knowledge, information, and belief, do hereby make application to the Clerk of the Orphans' Court of
e above County, for a license to marry. .d C
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Signature of Applicant Signatur of plicant
Sworn and subscribed to before me this
5th
March
A.D. 2007
Filed
March
5th
2007
day of
GLENDA FARNER STRASBAUGH
(Clerk of Orphans' Court)
wX~OOJq'.'lt)1!1.lit!~
(SEAL)
License Issued
January 4th
My Commission Expires
2010
No.
0000102
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