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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
David &6I;t~istophor War;,Q~NAME
23, SUBSCRIBED AND SWORN TO/AFFIRMED BEFOR
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 ~11to 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
COUNTY Dutchoss
g:~~g,vm \N3ppinger
~~~~~~R1368
NUMBER 85
1 ' A FULL NAME
FIRST
'"
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 393 90 28"1 "1
2, RESIDENCE A DQ,TATE) B Q~w-iW of Columbia
c, CHECK ONE "fJ CITY 0 TOWN 0 VILLAGE
AND
SPECIFY V'!3chington
o STREET ADDRESS 2010 K.lor.ma Road, NW ZIP 20009
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? ~ YES 0 NO
M~ / 2;9 / 1~0
3, A, AGE 28
4, EMPLOYMENT
3B, DATE OF BIRTH
A, USUAL OCCUPATION RCGcarch /\n3lyst
B, TYPE OF INDUSTRY OR BUSINESS Non profit
5 PLACE OF BIRTH ~)lil\~ lk~p '.A/i
/t1W S1?'Tt I ctJtl'NTR'f if' NOT USA)
6, FATHER
A, NAME John \^.'arron
6. COUNTRY OF BIRTH USA
7, MOTHER
A MAIDEN NAME Elizabeth Ku~ny
6. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 1
9, PREVIOUS MARRIAGES
A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
o
o
(2) 0 DEATH
B, HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
C, DATE LAST MARRIAGE ENDED?
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
o
o
o
~
{ SEAL }
'-..t-'
NAME (PRINT)
SIGNATURE~
DATE
NAME (PRINT)
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Rach~Il~.fr~n Fleisnm~\\URNAME
~
11. A. FULL NAME
FIRST
B, BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
0, SOCIAL SECURITY NUMBER 076-RR-44R4
12. RESIDENCE A DC(STATE) BDi~!~~ of Colllmbia
C CHECK ONE .,i!J CITY 0 TOWN 0 VILLAGE
~~~cIFYWashington
D STREET ADDRESS?n1 n K::Jlnr::Jm::J Rnad Nw ZIP20009
E. IS RESIDENCE WITHIN liMITS OF CITY OR INCORPORATED VilLAGE? ~ YES 0 NO
13, A, AGE 31 36. DATE OF BIRTH n? ~ 1 4Q77
~ONTH DAY '(~A~
14, EMPLOYMENT
A, USUAL OCCUPATION PHD Candidate
R TYPE OF INDUSTRY OR BUSINESS Frlllr.::Jtinn
15. PLACE OF BIRTH NE'lAIhllrnh Nv
(CITY, STATE I'COUNTRY1F NOT USA)
16, FATHER
,A NAME Eugene Harris Fleishman
B, COUNTRY OF BIRTHl I R A
17, MOTHER
A, MAIDEN NAME nnril=: \^,Fndp.r
B, COUNTRY OF BIRTH I I R A
1 B, NUMBER OF THIS MARRIAGE 1
19, PREVIOUS MARRIAGES
A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o n
DEATH
n
6. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C, DATE LAST MARRIAGE ENDED? / ~
MONTH DAY YEAR
D, ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
,.
2D, 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
o
o
DATE
07/10/2008
by New York Domestic
25, B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON'
TIME
MONTH
YEAR
MONTH
DAY
YEAR
AM
12:37PM
08 2008
07
11
2008
09
ITY 101
26, SOLEMNIZATION OCCURRED
TIME MO, DAY YEAR
TATE
27, TYPE OF CEREMONY
o ~ RELIGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED,
J3-2/t;g
29, OFFICIANT
NAME (PRINT)
TITLE
SIGNATURE ~
MAILING ADDRE
4-
STREET
30, WITNESS TO CEREMONY
PA LI Z ,Iv:i)
STAT
2B, PLACE WHERE MARRIAGE OCCURRED
A STATE NEW YORK 6. COUNTY })Jd-k ;,:,
c, LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
):! CITY OF 0 TOWN OF 0 VILLAGE OF /~i,; 7hl""
SPECIFY Th-e. Gre'.ndv i of:.~
/7 ~ I< i nal d i l3 c'v, (eV~'JcL
PC'liIa",/. '.7c'7 -e IJ.; I d f.., 01
31, WITNESS TO CEREMONY
NAME (PRINT) j e:+ ( " "
C!..A AJ T 0 ,z
7-/3- :;003
/015(;(
SIGNATURE~