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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c; 1368
~~~I~~~R 82
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Thnm~~ A Orr
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
np.n~~tciLJ inp.ttp. Ri~ltfR~NT SURNAME
.-l
1. A FULL NAME
11. A. FULL NAME
FIRST
FIRST
ll.
N
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Ri~lp.y - Orr
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER 109-64-8917
12 RESIDENCE A. NY B. nlltchp.ss
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND P hk .
SPECIFY oug eepsle
D. STREET ADDREss4 Edgewater Drive
B. BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER 120-60-0190
2 RESIDENCE A. NY B nlltr.hp.~~
(STATE) (COUNTY)
C CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND P hk .
SPECIFY oug eepsle
D. STREET ADDRESS 4 Edgewater Drive
ZIP 12603
DYES tJ NO
A907
YEAR
3. A AGE 32
04
MONTH
ZIP 12603
o YES~ NO
/?4 /1Q70
DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 41 3B. DATE OF BIRTH O~ /07
MONTH DAY
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3B. DATE OF BIRTH
4. EMPLOYMENT
A USUAL OCCUPATION f:nrrp.r:tiom:; Officp.r
B. TYPE OF INDUSTRY OR BUSINESS Law Enforcement
5. PLACE OF BIRTH Middletown, Ny
(CITY. STATE / COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Education
15. PLACE OF BIRTH Alexandria. Va
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A NAME Andrew Russ Risley
'B. COUNTRY OF BIRTH USA
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6. FATHER
A. NAME Kp.nnp.th A Orr
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Gerda E. Spahn
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
DEATH
o
17. MOTHER
A. MAIDEN NAME Judy Ann Markley
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 2
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
19. PREVIOUS MARRIAGES
A.NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) C"I" DIVORCE (31 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 09 / 08 / 2003
MONTH DAY. ~ YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~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 09/08/2003 PouQhkeepsie. Nv l'1
2ND
3RD
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
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say, th
as to my right to enter into the marn
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22. SIGNATURE OF BRIDE.
Yl t2.(i j .<5J
~c RENT NAME
FOR E;' (
'-Ul
This license authoriz the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~t1 to perfonTl 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 . Master 0
TIME MONTH YEAR
SEAL SIGNATURE ~ DATE 07/07/2008
MAIW'1G f.IJPREI'iS 1 0 21 AM
'-v-I LU MldOlebu Rd, WappinQers Falls, NY 12590 : 07
STREET CITYITOWN STATE ZIP PM
~~~R~~RT~~~ IO~O~~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27 TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 1 ~IVIL
DATE AND AT THE TIME AND '6/SlAM IJ -
PLACE INDICATED. PM
MONTH
YEAR
09
05 2008
08
2008
28. PLACE WHERE MARRIAGE OCCURRED
29. OFFICIANT
NAME (PRINT)
A. STATE NEW YORK B. COUNTY'l::>i l~ ~~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF QA1iLLAGE OF
SPECIFY L (J (J pr -; ~-e I