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23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) John C. Master
TIME MONTH YEAR
SEAL SIGNATURE ~ DATE
MAILING ADpRE~S AM 1 0
'-v-I 20 Mldale 03: 19PM
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Rnn::llrl Ha\les Hammond
MIDDLE ] CURRENT SURNAME
COUNTY Dutchess
CITYrrOWN Wappinger
~~~~~c; 1368 .
~5~'~J~R 117
1. A. FULL NAME
FIRST
ll.
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B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 128-60-3922
2 RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWNol] VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDRESS 1548 Apt 9b Route 9 ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY DR INCORPORATED VILLAGE? '6 YES 0 NO
3. A. AGE 40 3B. DATE OF BIRTH 08 / 05 /1969
MONTH OA Y YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION T e::lcher
B. TYPE OF INDUSTRY OR BUSINESS Education
5. PLACE OF BIRTH Beacon NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME n::lniel Hammond
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Christa Schmid
B. COUNTRY OF BIRTH Germany
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
13) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
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21. SIGNATURE OF GROOM~
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29. OFFICIANT
NAME (PRINT)
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Yi
'I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Erika Nichelle Cole
MIDDLE CURRENT SURNAME
~
1 1. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Hammond
(OPTIONAL - SEE REVERSEb68 74 2762
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE ANY BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN"6 VILLAGE
~~~CIFY Elmsford
D. STREET ADDRES~64 Nab Hill Dr ZIP 10523
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? '."'0 YES 0 NO
)12 )971
DAY YEAR
13. A. AGE38
09
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL occuPATloNAdministrator Assistant
B. TYPE OF INDUSTRY OR BUSINESS Hospitality
15. PLACE OF BIRTH Poughkeepsie I NY
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME John R. Cole
. B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Helen Watson
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- ~ YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
o
o
o
1ST
2ND
3RD
o 0
o 0
o 0
o 0
rmation I provided is true and that I declare that no legal impediment exists
~ 'VI ,UrtL
USE CURRENT NAME
DATE 10/02/2009
-
by New York Domestic
MONTH
YEAR
03
2009
01 2009
12
28. PLACE WHERE MARRIAGE OCCURRED
'0 CIVIL
A. STATE NEW YORK B. COUNTY DlAic.tt <fJ sS
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~ILLAGE OF
SPECIFY lIJ4~VI(,\ 'j<N"'S ~Oll L
NAME (PRINT)