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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
COUNnOutcbess
CITyrrowl'\Nappinger
~~J~~c~ 368
~Q~J~J~R43
1. A.
FUll NAME ~ Stll!Vera ToIhP-rt
I MIDDLE
CURRENT SURNAME
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B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE.l.
D. SOCIAL SECURITY NUMBER 152-7 L3RQ'
2. RESIDENCEA.~ B. ~g.1
C. CHECK ONE 0 CITY.tJ TOWN 0 VILLAGE
AND
SPECIFY la~ f-li~
D. STREET ADDRES~ [)afrAr* OrlvA ZIP 07034
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YESI'b NO
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3. A. AGQ4
4. EMPLOYMENT
A. USUAL OCCUPATION Sales
B. TYPE OF INDUSTRY OR BUSINESSst8P~
5. PLACEOFBIRT~-~ .
, IFN
6. FATHER
3B. DATE OF BIRTH
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A. NAME Steve Talbert
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Loretta &aI~
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
o
DEATH
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B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNUlED, PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
YEAR
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
11. A.
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
FULL NAMEKimbel'ly Marie Schwalb
FIRST MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGETDlbert
(OPTIONAL - SEE REVERS~ft'" - "'A'72
D. SOCIAL SECURITY NUMBER uoo-ou-.t::..
12. RESIDENCE.N.ut .1Il!RlfI!!U B.MOrriS
"--(~T~ (COUNTY)
C. CHECK ONE 0 CITY otJ TOWN 0 VilLAGE
~~~CIP1ske Hawatha
STREET ADDRES88A D8fr8ck Drtve
ZI~7034
o YE~ NO
19'16
YEAR
D.
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AG~ 13.B. DATE OF BIRTH 1? 1-8
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATIOrSales
B. TYPE OF INDUSTRY OR BUSINEssClngular Wreless
15. PLACE OF BIRTt-F?JIrIs France
(CITY, ~TATElCOUNTRY IF NOT USA)
16. FATHER
A. NAM~Obert SdwvaIb
B. COUNTRY OF BIRTU S A
17. MOTHER
A. MAIDEN NAMERoe;P- StllftN
B. COUNTRY OF BIRTtJ S A
lB. NUMBER OF THIS MARRIAGE 1
19. 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 (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNUlED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
YEAR
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o
o 0
o 0
o 0
o 0
gal impediment exists
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21. SIGNATURE OF GROOM"
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(.)
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NAME (PRINT)
SIGNATURE ..
DOH-9B (llI9B)
. SIGNATURE OF BRIDE
TIME
MONTH
23. SUBSCRIBED AND SWORN TO BEFORE ME 0510312006
SIGNATURE OF TOWN OR CITY CLERK" DATE
This license authorizes the marriage in New York St of the bride and groom named abDve by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremDnies withi ew York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is t be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK _.' ...., '. . 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME(PRINT)~~~,
SEAL SIGNATURE "Es~""!.""'tll~d<.l(e~ DATE 05ID3I2OO6
'-v-I M~Mi:t~~hRd Wanninoer Falls, Nv 12590 10:15 ~M 05
~ . ......Cii'!'ITOWN :::::- STATE ZIP M
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 2~TYPE OF CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY EAR 0 RELIGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND t./ n /
PLACE INDlCATEO. M j- / / [/ D 9 0 OTHER, SPECIFY
I-W<c 29. OFFICIANT I< & ;-r)-I W. 7iI />? L-, J ;./ TITLE
NAME (PRINT) L "/
~ SIGNATURE" / c.::z:t:;:~~J DATE
i= MAILING ADDR5Sj "0:"#. '.J?6 {. /-u': ~ f~_, . ~ I ..)
a: L a ~ -/"'2> V'j v "1/ 0- /pJ !!1V'tN 1tJA..{.~ (] ,
W STREET CITYrrowN/1 /
(.) 30. WITNESS TO CEREM
YEAR
MONTH
YEAR
04
2006
07
02 2006
2B. PLACE WHERE MARRIAGE OCCURRED )
A. STATE NEW YORK B. COUNTY "1)J'tcJ}!.S
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY 00 TOWN ~F 0 VILLAGE OF
SPECIFY O'l/) I'J..e.4-
31.
NAME (PRINT)
SIGNATURE ..