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COUNTY Dutchess
CITYrrOWN Wappinqer
~~~:~c~ 1368
~~~~;~R 133
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Paul Gerard Kutch
MIDDLE CURRENT SURNAME
I
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kristin Lynne Oqozalv
MIDDLE CURRENT SURNAME
~
1 . A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 2 2775
D. SOCIAL SECURITY NUMBER 126-5-
2 RESIDENCEA New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY i'i'1' TOWN 0 VILLAGE
AND W .
SPECIFY applnqer
D. STREET ADDRESS 1 Cady Lane ZIP 12590
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Kutch
(OPTIONAL - SEE REVERSE) 374-02-7122
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Pouqhkeepsie
o STREET ADDRESS 37 Raymond Avenue ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
08 /12 /1'973
DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES i'1 NO
09 / 16 / 1959
MONTH DAY YEAR
13. A. AGE 33
3. A. AGE 46
38. DATE OF BIRTH
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Law Enforcement
B. TYPE OF INDUSTRY OR BUSINESS D. C. Sheriff's Office
5. PLACE OF BIRTH Town Of Pouqhkeepsie
(CITY, ST ATE / COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Social Worker
B. TYPE OF INDUSTRY OR BUSINESS N Y S 0 M H
15. PLACE OF BIRTH Detroit, Michigan
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME James Clark Ogozaly
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Martha Mary Niznik
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEaTH
6. FATHER
A. NAME Georqe Kutch
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Helen Billik
8. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
B. 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
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CI'fY/COUNTY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
(2) 0 DEATH
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, t
as to my right to enter into the marrr e S
21. SIGNATURE OF GROOM ~
o
o
o
o 1ST
o 2ND
o 3RD
o 4TH
. f that the infor
o
o
o
ists
w
en
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23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
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 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 CITYJC~ERKC M t rso 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) onn . as e n
{SEAL SIGNATURE ~ _ _ DATE 08/23/200 liME MONTH YEAR MONTH DAY YEAR
I....- -.J MAII~tH&Yraijfe ppinger Falls, NY 12590 AM 08 24 2006 10 22 2006
-v- 05:56pM
STREET STATE ZIP
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER. ~
SONS NAMED ABOVE ON THE 0 ELIGIOUS
DATE AND AT THE TIME AND L
PLACE INDICATED. Op 9 0 OTHER, SPECIFY
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY
50PF6'~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~ILLAGE OF
SPECI~tf'\lI~N B A Y5>
TilLEr ~A,.( {I/I; z.st
DATE Sfpl-- ~ ~ ~ "
-jL (rJ:Z
STATE ZIP
31, WITNESS TO CEREMONY
NAME (PRINT) F2- Oi'C rrv CE
gAR'AiA/
SIGNAlURE~
DOH-98 (03/2006)
SIGNATUR
./