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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christopher Thomas Morris
FIRST MIDDLE CURRENT SURNAME
COUNTY Dutchess
C1TYfTOWN Wappinger
DISTRICT 1368
NUMBER
REGISTER 30
NUMBER
1 . A. FULL NAME
0-
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)1 09-74-5466
D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. NY B. Dutchess
(STATE) .L. (COUNTY)
C CHECK ONE 0 CITY 0 TOrrNLJ VILLAGE
AND W' FI
SPECIFY applngers a s
D. STREET ADDRESS 16 High ~t
3. A. AGE 25
1~b~U
ZIP
"-
YES 0 NO
/1983
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
06 / 20
3B. DATE OF BIRTH
MONTH
DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Claims Examiner
B. TYPE OF INDUSTRY OR BUSINESS Health Care
5. PLACE OF BIRTH Poughkeepsie, NY
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Thomas Edward Morris Jr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Mary Catherine Damm
B. COUNTRY OF BIRTH U S A
8. 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?
(3) 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
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
"I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Nicole Sara Dohrenwend
~
11. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME). IF DIFFEI)ENT
C SURNAME AFTER MARRIAGE MOrriS
(OPTIONAL - SEE REVERSE)129-7 4-6761
o SOCIAL S~~ NUMBER
12. RESIDENCE A. B LJutchess
(STATE) .L (COUNTY)
C. CHECK Ol'lt;. 0 CITY D- T~WN U VILLAGE
AND vvapplngers railS
SPECIFY 16 HI h St
D. STREET ADDRESS g
12590
ZIP
.,
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORAT1D VILLAGE? 0 YEi M ~O
13. A. AGE25 38. DATE OF BIRTH 2 ,,21 ~
MONTH DAY YEAR
14. EMPLOYMENT ,
A. USUAL OCCUPATION Quality Assurance
B. TYPE OF INDLlS.TRY OBhlilUSINESS,JewerlY inspection
t-'oug IKeepSle NY
15. PLACE OF BIRTH '
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Robert Steven Dohrenwend
U::iA
B. COUNTRY OF BIRTH
17. MOTHER H 'd' D H 'It
A. MAIDEN NAME el I awn ami on
U::iA
B. COUNTRY OF BIRTH 'I
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DlaORCE CIVIL A~ULMENT
D~TH
(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
1ST
2ND
3RD
o
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22. SIGNATURE OF BRIDE ~
~
YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER. SPECIFY
~VIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~l-.k kess
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY t ,t) a...t j1 ; 'l p r
29. OFFICIANT
NAME (PRINT)
STREET CI
3D WITNESS TO~MONY 00
NAME (PRINT) ~ t\
SIGNATURE~ ~v"""
DOH-98 (0312006)
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