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COUNTY Dutchess
CITYffOWN Wappinger
~~~:~c: 1 368
~~~I:~~R 171
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DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
RnhFH!.ID~~nnr. Mr.1 7:LMilE~Ji~RNAME
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Nina Verena Anna Transfeld
MIDDLE CURRENT SURNAME
~
1. A. FULL NAME
11. A FULL NAME
FIRST
FIRST
"-
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Mclaughlin
(OPTIONAL - SEE REVERSE) 6985
D. SOCIAL SECURITY NUMBER 050-98-
12. RESIDENCE ANY B.Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY WappinQer
D. STREET ADDRES&4 Chelsea Ridge Drive: Apt
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER 622-01-9491
2 RESIDENCE A. NY B. nlltr.hp.!=:!=:
(ST A TEl (COUNTY)
C. CHECK ONE 0 CITYIlJ TOWN 0 VILLAGE
AND W .
SPECIFY appmger
D. STREET ADDRESS 4 Chelsea Ridge Drive: Apt ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES..o NO
3 A AGE 31 38. DATE OF BIRTH n? / n~ / 1 ~77
MONTH DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13.A AGE20 38. DATE OF BIRTH 12 ,,09
MONTH DAY
ZIP 12590
DYES -6 NO
;(987
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Rp.tail Manager
8. TYPE OF INDUSTRY OR BUSINESS Retail
5. PLACE OF BIRTH Gilrov, California
(CITY, S1'ATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME William Flmp.r Mr.lallghlin
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Sandie Rae Yarn
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 2
14. EMPLOYMENT
A. USUAL OCCUPATION Actress
B. TYPE OF INDUSTRY OR BUSINESS Entertainment
15. PLACE OF BIRTHEngelskirchen. Germany
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A NAME Paul Martin Transfeld
'B. COUNTRY OF BIRTHGermany
17. MOTHER
A. MAIDEN NAME Annemarie Boscanin
B. COUNTRY OF BIRTHGermany
1B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES 19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH DIVORCE CIVIL ANNULMENT
1 0 0 0 0
B. HOW DID LAST MARRIAGE END? (3) I!'l DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 06/ 17 / 2005 C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR MONTH DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
,.
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUEO AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
06/17/2005Fresno,CA I!I' 0 1ST 0 0
o 0 2ND 0 0
o 0 ~D 0 0
o 0 4TH 0 0
and belief that the information I provided is true and}hat I declare that no legal impediment exists
'.... 22SIGNATUREOFBRIDE~ {//./()(.t ,--r(tft1s-t,(d
" USE CURRENi"NJiME
DATE 11/07/2008
DEATH
o
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and sa
as to my right to enter into the m na
21. SIGNATURE OF GROOM ~
w
en
z
w
o
::::i
USE CURRE
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in Newflork State of nle 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) J~ ~son
{ SEAL SIGNATURE~ '~. C' , V4,-:::::' DATE 11/07/2008
MAILING ADDRESiV,! 11 :24AM 11
'-v-I STRf~ Middlftbush Rd, Wap~~~~JS Falls'sT~r 1259~p PM
~~~R~~~Ri~t~ IO~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY 1 --/'CIVIL
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS Il6 (
DATE AND AT THE TIME AND
PLACE INDICATED. \ ( 0hlJ-' 9 0 OTHER, SPECIFY
01
06 2009
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
DAY
YEAR
YEAR
MONTH
TIME
MONTH
08
2008
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY 'Dv''X-t{l2'S5
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WN OF 0 VILLAGE OF
29. OFFICIANT
NAME (PRINT)
TITLE )J( ~I ~!Z olr I cf f.....
DATE~ \ I I '2.0C ~
f
tv' 25'70
STATE ZIP
31. WITNESS TO CEREMONY
SPECIFY (;JA f'p I rJ( rz (l
NAME (PRINT)
NAME (PRINT)
SIGNATURE~
DOH-9B (03/2006)
SIGNATURE~