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COUNTY nlltchA~~
CITYfTOWN W::IppingAr
~~~:~c; 1 ~RR .
~~~li~~R 11 9
~ I #4.. I I:: vr .'11:: YV 'vn~
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
And~i? Palll ThgJinft9SURNAME
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~
1. A. FUll NAME
H::Inn::l RllAger
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT R ~ ig e r
C. SURNAME AFTER MARRIAGE Thnm~!=:
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE ANY
(STATE)
C. CHECK ONE 0 CITY ~
~~~CIFY Fishkill
o STREET ADDREss600 Clermont Lane
11. A. FULL NAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
o SOCIALSECURITYNUMBER OO~-7R-4fiR7
2 RESIDENCE A. N\STATE) B. r;!!t~)ASS
C. CHECK ONE 0 CITY..tJ TOWN 0 VILLAGE
~~~CIFY Fi~hkill
o STREET ADDRESS 600 Clermont Lane ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES~ NO
3. A. AGE 36 3B. DATE OF BIRTH MO~ /~? / JE~l2
4. EMPLOYMENT
A. USUAL OCCUPATION Pilot
B. TYPE OF INDUSTRY OR BUSINESS Commercial Airline
5. PLACE OF BIRTH TIJ5;C::IIOO5;::IL AI::Ibama
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME nnn~ld r.Ahrnn Thnm::l~
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME AdAlheid Fischlin
B. COUNTRY OF BIRTH Switzerland
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
n 0
B. Dutchess
(COUNTY)
TOWN 0 VILLAGE
ZIP 12590
DYES ..0 NO
.J(971
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE ~R 3B. DATE OF BIRTH 1 0 ,,09
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Pharmacist
B. TYPE OF INDUSTRY OR BUSINESS Pharmaceutical
15. PLACE OF BIRTH Zurich, Switzerland
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER II
A. NAME Emanuel Hans Ruger
'B. COUNTRY OF BIRT~witzerland
17. MOTHER
A. MAIDEN NAME Margrit Hofstetter
B. COUNTRY OF BIRTHSwitzerland
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
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
MONTH DAY
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
w
en
z
w
o
;:j
o 0 1ST 0 0
o 0 2ND 0 0
o 0 ~D 0 0
o 0 4TH 0 0
f my knowledge and belief that the information I provided is true and /~;a~diment exists
USE CU ./7 J ~ NAME
23 ~:::Ac;.~~~Do~N.fo~~Ot~ ~~A~mM:~ BEFORE M DATE 08/28/2008
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
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 C. Masterson
TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ DATE 08/28/2008
MAILING ADDRESS AM
'-..,-I 20 Middle sh Rd, Wapoinqers Falls. NY 12590 12:03PM 08
STREET CITYITOWN STATE ZIP
~~~R~~RT~~~ 'o~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. AY YEAR 0 0 RELIGIOUS 11\YCIVIL
OATE AND AT THE TIME AND 'I' '
PLACE INDICATED. I () 13 9 0 OTHER, SPECIFY
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say, that
as to my right to enter into the mamage st
21. SIGNATURE OF GROOM~
YEAR
29
2008
10
27 2008
28. PLACE WHERE MARRIAGE OCCURREif
A. STATE NEW YORK B. COUNTY~~Ul
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~ILLAGE OF
SPECIFY U \ ~ pi (bf (
SIGNATURE~