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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Do'wla~ .Iame~ Mur::ray
FIR MIDDLE
CURRENT SURNAME
(THIS SPACE FOR STATE USE ONL Y)
COUNTY Dutchess
CITYfTOWN Wappinger
~~~~~~ 1368
~5~~J~R 23
L 0 SUPPLEMENTAL FILE
11. A.
FROM THE BRIDE
FULL NAME .AuQr~ May CaRifWa
CURRENT SURNAME
B 81RTH NAME (MAIDEN NAME), IF DIFFERENT Bischoff
c. s~~~~~JN~~~~~t~~e~~sl)Aurray
o SOCIAL SECURITY NUMBER 127 62 17.04 4
12. RESIDENCE A. N v B. D' ..,.hOEE
l'STATE) ~~
C. CHECK ONE 0 CITY Ii1 TOWN 0 VillAGE
~~~CIFY Fishkill
D STREET ADDRESS 11F:. Millhnlbmd nriv~ ZIP 12524-
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
~TH .oSDAY 1'66lAR
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B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER 114-54-9135
2. RESIDENCE A N JrATE) 8. q~wss
C CHECK ONE 0 CITY i'\ TOWN 0 VilLAGE
~~~CIFY Fishkill
D STREET ADDRESS 11 C Millholland Drive ZIP 1 ~5'4
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3 A. AGE 38 38. DATE OF BIRTH MQi /1Jl / ~Ri7
4. EMPLOYMENT
A. USUAL OCCUPATION MRintp.nRnr.e-
8. TYPE OF INDUSTRY OR BUSINESS Metro Nnrth
5 PLACE OF BIRTH Manhattan New York
(CITY, STATElCOUtfTRY IF NOT USA)
6. FATHER
A NAME .IRm~~ .In~p.ph Mllrrl''lY
8. COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Barbara Schankweiler
8. COUNTRY OF BIRTH I J ~ A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o n
1 0 0
8. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C, DATE LAST MARRIAGE ENDED? MONTPS / 3A~ / 1~
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~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
13, A. AGE 38
14. EMPLOYMENT
13.B. DATE OF BIRTH
A. USUAL OCCUPATION Principal Program Assistant
B. TYPE OF INDUSTRY OR BUSINESS Dutcbe5s County
15. PLACE OF BIRTH~9M,~8fR~~J~"~!f York
16. FATHER
A. NAME Howard Thom as Bischoff, Sr.
B. COUNTRY OF BIRT..... J 5 A
17. MOTHER
A MAIDEN NAME Barbara Jean Dangerfield
8. COUNTRY OF BIRTt{J S A
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
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DEATH
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 YEAR
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
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1ST 0 0 1ST 05/19/1998 Dutchess Co., New York
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true
as to my right to enter into the rriage state.
21. SIGNATURE OF GROOM ~
[i' 0
o 0
o 0
o 0
gal impediment exists
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23. SUBSCRIBED AND SWORN TO BEFORE
SIGNATURE OF TOWN OR CITY CLERK.
This license authorizes the marriage in New York State 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 cheeked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK, ...... . '. . 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) IIOh~.. ~r~()p .p..... .. TIME MONTH YEAR MONTH
SEAL SIGNATURE. .... I. '.:..', ," -.:,"~' DATE03/29120D6
MAILING ADDRESS . . . . AM
~ sT?EqTMiddlebIJ~h Rd, WRPpigQ~J'wf811f;, 1\I"{;rAt?59D ZIP PM 03 30 2006 05 28 2006
~~~R~~~Ri~~~ IO~O~~~N~:~ 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~ 28. PLACE WHERE MARRIAGE OCCURRED
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 ~CIVll NEW YORK ~II C ILo4ft
DATE AND AT THE TIME AND A. STATE B. COUNTyCJ;lt"I" IQCI
PLACE INDICATE 90 OTHER, SPECIFY
YEAR
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /'
o CITY OF 0 TOWN OF ~ILlAGE OF
SPECIFY wllrf'fJ 1-d'tt'1.6. "r~
SIGNATURE