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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FIRST W~rLr Joseph ~~urSURNAME
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO~CE CIVIL ANN~LMENT
!I
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT ~fil5>EATH
C. DATE LAST MARRIAGE ENDED? 12/ 06 / 2 .
MONTH r,/' 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
(M9[1'HODAY~YARl. p(CITYICQUlITY, STATEJpOUtQ1lY, IF NQT,USAj SELF SPOUSE
1ST 1 "Loll 6/~uuo ougnKeepsle, New YOrK 0 Dr,/' 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I duly swear/affirm, de knowledge and belief that the information I provide
as to my right to enter into
21. SIGNATURE OF GROOM~
COUNTY Dutchess
CITY/roWN Wappinger
~~J~~ 1368 .
~~~~~R 94
1. A. FULL NAME
n.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 262 72 681 0
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY I:!' TOWN 0 VILLAGE
~~CIFYW appinger
D. STREET ADDRESS 86 Diddell Road
ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES t5 NO
12 / 04 / 1944
MONTH DAY YEAR
3. A. AGE 61
3B. DATE OF BiRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Farrier
B. TYPE OF INDUSTRY OR BUSINESS Self-employed
5. PLACE OF BIRTH Miami, Florida
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME John Mathew Wells
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Roselma Helen Giles
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARF,lIAGE 2
DEAOH
~
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23. SUBSCRIBED AND SWORN T
SIGNATURE OF TOWN OR CI
::iTA 1 k t'ILoE: NUMtll:."
(THIS SPACE FOR STA TE USE ONL Y)
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Donna Marie Scheel
MIDDLE CURRENT SURNAME
--1
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Wells
(OPTIONAL - SEE REVERSE) 124-42-7468
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY rf TOWN 0 VILLAGE
~~~CIFY WapQinQ..er
D. STREET ADDRESS 86 Diddell Road ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 6 NO
12 /24 /f949
DAY YEAR
13. A. AGE 56
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Court Stenographer
B. TYPE OF INDUSTRY OR BUSINESS Babiarz Court Reporting
15. PLACE OF BIRTH Queens, New York
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Hugo Scheel
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Kathryn Angerame
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV8RCE CIVIL AN~LMENT
D~H
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.'- YEAR
B. HOW DID LAST MARRIAGE 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) (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
by New York Domestic
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
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 onl for the purpose of a second or subsequent ceremony.
24. TOWN OR C~<6LftW C. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
~
{ SEAL }
"-v-I
TIME
MONTH
2006
09
1 0 2006
YEAR
MONTH
YEAR
SIGNATURE ~
MAIL2le 'Ml~te
07/12/200
DATE
ppinger Falls, NY 12590
03:3~~
07
13
ZIP
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
NAME (PRINT)
SIGNATURE~
DoH-98 (0312006)
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~\l
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WN OF 0 VILLAGE OF
SPECIFY ~~~1N~7.
1~
NAME (PRINT)
SIGNATURE~