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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Scott Thomas Marshall
MIDDLE CURRENT SURNAME
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say, that to the best of
as to my right to enter into the mam ge state,
21. SIGNATURE OF GROOM.
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE
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 Yo 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.
r-"'-.. 24. TOWN OR CITY 6W~' C. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
TIME MONTH YEAR
SEAL SIGNATURE ~
MAIL2re"'M' 0 rf.M 09 13 2006
'-v-' 2:2~M
STREET ZIP
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~: 1368 .
~5~1~~~R 148
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 077-68-5908
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN r:! VILLAGE
~~CIFY WappinQers Falls
D. STREET ADDRESS 8 Church Street ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? dYES 0 NO
01 / 28 / 197
MONTH DAY YEAR
3. A. AGE 28
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Salesman
B. TYPE OF INDUSTRY OR BUSINESS Dutchess Beer Dlst.
5. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Thomas Michael Marshall
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Linda Darlene Van Voorhis
B. COUNTRY OF BIRTH USA
1
B. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO'(fE' CIVIL ANN~LMENT
DEA~
B. HOW DID lAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED? .
(3) 0 ANNULMENT
/ /
(2) 0 DEAJIi.
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) (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
W
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STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
Lo
~
SUPPLEMENTAL FILE
FROM THE BRIDE
Karoline Elisabeth BobinQer
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Marshall
(OPTIONAL. SEE REVERSE) 118-60-8525
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) ....J (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN LJ VILLAGE
~~~CIFY Wa~ingers Falls
D. STREET ~8 Church street ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? d' YES 0 NO
08 /29 /1977
DAY YEAR
13. A. AGE 29
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Student
B. TYPE OF INDUS1flY OR BUSII'/.E,SS D. C. C.
15. PLACE OF BIRTH L;armel, New York
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Peter J. Doyle
'B. COUNTRY OF BIRTHU S A
17. MOTHER .
A. MAIDEN NAME Erika C. Boblnger
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL AN~LMENT
D~H
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. '.- YEAR
B... HOW DID, I,AST MA.RFlIAGE 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, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
1ST
2ND
3RD
o 0
o 0
o 0
o 0
t no legal impediment exists
09/12/2006
MONTH
YEAR
11
11 2006
STATE
27. TYPE OF CEREMONY
o ~~IGIOUS
9 0 OTHER, SPECIFY
TITlE
4.
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY];uTG/{fS>
tt? C. &,isr
/0 /t1-/d'
.
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) .'
o CITY OF 0 TOWN OF ~LLAGE OF
SPECIFY t1Jr1;fr..u(i-a<s FlfiJ-s
NAME (PRINT)
SIGNATURE~