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1 . A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Mark Damian Oertel" Jr.
FIRST MIDDLE CURRt:NT SURNAME
I
STATE FILE NUMBER
(TH/S SPACE FOR STA TE USE ONL Y)
I
COUNTY Dutchess
CITYrrOWN WappinQer
~~~~~~ 1368 .
~G~I:J~R 99
~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kri~~LEMarie Sa~~~~NT SURNAME
11. A. FULL NAME
FIRST
0-
N
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Savino- Oertel
(OPTIONAL - SEE REVERSE) 135-74-9821
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New Jersey B. Beraen
(STATE) (COUNTY)
C. CHECK ONE D CITY r( TOWN D VILLAGE
~~~CIFY Lyndhurst
D. STREET ADDRESS 313 Forest Avenue ZIP 07071
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIlLAGE? DYES ct NO
13. A. AGE 26 3B. DATE OF BIRTH 06 /13 /f 980
MONTH DAY YEAR
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 069 64-4117
D. SOCIAL SECURITY NUMBER -
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE D CITY I!l' TOWN D VILLAGE
~~~CIFY WappinQer
D. STREET ADDRESS 24 A Alpine Drive
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? D YES ~ NO
03 / 05 / 1980
MONTH DAY YEAR
3. A. AGE 26
3B. DATE OF BIRTH
w
~
4. EMPLOYMENT
A. USUAL OCCUPATION Militarv / Student
B. TYPE OF INDUSTRY OR BUSINESS U. S. Marines
5. PLACE OF BIRTH Hudson, New York
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Mark Damian Oertel, Sr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Barbara Ann Stalker
B. 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
14. EMPLOYMENT
A. USUAL OCCUPATION Student
B. TYPE OF INDUSTRY OR BUSINESS Ramapo College
15. PLACE OF BIRTH Hackensack, New Jersey
(CfTY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME James Savino
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Kathleen Hitchcock
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
DE.[)H
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) D ANNULMENT
/ /
(2) D DEATH
(3) D DIVORCE
(3) D ANNULMENT (2) D DEATH
/ /
.'- YEAR
B. HOW DID LAST MARRIAGE END?
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) (CfTY/COUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
C: DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D NO
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLlLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CfTYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST D 0 1ST D D
2ND D D 2ND D D
3RD D D 3RD D D
4TH D D 4TH D D
I duly swear/affirm, depose and say, that to the best of my knowledge nd belief that the information I provided is t declare that no legal impediment exists
as to my right to enter into the mamage state. ~ I
21. SIGNATURE OF GROOM. ~ D (J",v .
USE CU ENT N
23. SUBSCRIBED AND SWORN TO/AFFIRMED 8EFORE ME 07/18/2006
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State of the bride and groom named above by any pe on authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE LY.
D If checked, this license is to be used onl for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CfTYJCI,ERK C M t 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) onn . as erson
{SEAL} SIGNATURE ~
MAI~ wn
~
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
TIME
MONTH
YEAR
MONTH
YEAR
DATE 07/18/200
appinger Falls, NY 12590
07
19
2006
09
16 2006
ZIP
AM
12:06pM
STATE
27. TYPE OF CEREMONY
CfTYlTOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
28. PLACE WHERE MARRIAGE OCCURRED
11l?J CIVIL
A. STATE NEW YORK B. COUNTY U L.$ Ie~
o D RELIGIOUS
9 D OTHER, SPECIFY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF J2 TOWN OF D VILLAGE OF
SPECIFY.5 h fl vJ Ii- 1'1 G u, AI ~
) :J.. () r.
ceA..r"
TITLE f.' r ~ fA .S" ..,.-; c -e J l) '-I
DATE $' - / ;;L - (;) ,
1'1i( W Y () n 1<::
STATE /
~~I~n~~~ ~I? k;) e. E 4t::. L
SIGNATURE~ ~ ~d --c ~ ~ -
MAILING ADDRESS
J-9'-fl'PI~reJt'_:B'I,efh If i) W4-/...LI<.~ L~
STREET crrtrrowN
"')
s~ "hJ 0
NAME (PRINT)
SIGNATURE~
NAME (PRINT)
SIGNATURE~
DOH-98 (0312006)