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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
QImlar MayetlDDlE
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
COUNTY Ot.Itdless
CITYIT?WN WappiRgef
DISTRIl:T
~~~~~R 1368
NUMBER 9
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. FUUL NAME E~ Rese H*DlE
CURRENT SURNAME
CURRENT SURNAME
Il.
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B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE U.. -f
(OPTIONAL. SEE REVERS!l"''"'''J'~
D. SDCIAL SECURITY NUMBER 07-4 78-8292
B'D~
VILLAGE
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. N.T~DFk B. ~
C. ~~6CK ONE 0 CITY ~ TOWN 0 VILLAGE
SPECIFY Wappinger
D. STREET ADDRESS 1094 Route 9 Unit 11 ZIP 12524
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlLAGE? 0 YES,i!J NO
MQQ / ~ / 1.i86
12. RESIDENCE A. NertNA~)BFk
C. ~~6CK ONE 0 CITY I;jll TOWN 0
SPECIFY V'Jappinger
D. STREETADDREss1094 Route 9 Unit 11 ZIP 12524
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
13. A. AGE 'V\ 13.B. DATE OF BIRTH ....,. L_ ~ L:"_
~ ~TH 2eDAy ~AR
14. EMPLOYMENT
3. A. AGE 19
4. EMPLOYMENT
3B. DATE OF BIRTH
A. USUAL OCCUPATION R8GI88Iioo Aid
B. TYPE OF INDUSTRY OR BUSINESS \..~Rg8te . Dutchess
15. PLACE OF BIRTH ~.~"'M~.
16. FATHER
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A. USUAL OCCUPATION NORe
B. TYPE OF INDUSTRY OR BUSINESS None
5. PLACE OF BIRTH I~~~
6. FATHER
A. NAME Peter othmar Mayer
B. COUNTRY OF BIRTH Qermlny
7. MOTHER
A. MAIDEN NAME Urlke Schultz
B. COUNTRY OF BIRTH GennaA)'
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0 0
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT 12) 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 ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATElCOUNTRY. IF NOT USA) SELF SPOUSE
A. NAME RabBIt ChallIS Hale
B. COUNTRY OF BIRTHU S ...
17. MOTHER
A. MAIDEN NAME Mar)" Anne Clarke
B. COUNTRY OF BIRTHU S "
1B. NUMBER OF THIS'MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
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DEATH
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B. HOW DID LAST MARRIAGE ENO? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
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(2) 0 DEATH
(3) 0 ANNULMENT
/ /
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, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
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1ST 0 0 1ST
2ND 0 0 2ND
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I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information 1 provided is tru
as to my right to enter into the marriage st
21. SIGNATURE OF GROOM. 0 22. SIGNATURE OF BRIDE ·
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23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK. DATE
This license authorizes the marriage in New York St person authorized by New York Domestic
Relations Law ~ 11 to perform marriage ceremonies withi ew 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 CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
~
{ } "M'("',"~~
SEAL SIGNATURE. . ". DATE Q2JD9QOO& TIME
MAILING ADDRES. 11"18 AM
'-v-/ s,iQ Middletgh Rei; Wa~f~lsr N"{rA~ ZIP . PM
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 CIVIL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
YEAR
MONTH
YEAR
MONTH
02
10
2006
04
10 2006
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ';[;2..... 1'l~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF.. ~ILLAGE OF P. J I.
SPECIFY wAPP,ttk~ ~
29. OFFICIANT
NAME (PRINT)
NAME (PRINT)
SIGNATURE.
DOH.98 (11/98)
NAME (PRINT)
SIGNATURE.
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',' L \~~e-r--.. --C-\('~~ hk.IJ4):oI33842
N Quahtlea In Dutchess County fLpzo
Term Expires September 30, ~ '.,
. ..
Abstammungsurkunde
E
(Standesamt
Uberlingen (Bodensee) -/-
NT. 347/1986
Othmar Mayer. mannlichen Geschlechts. -/-
ist am
19. September 1986 -/-
Uberlingen -/-
in
gebor
Eltern:
Peter Othmar Mayer. katholisch. und Ultike Mayer
geb. Schultz, katholisch. beide wohnhaft in Sipp-
lingen. -/-
Anderungen des
Geburtseintrags:
-/-
(Bodensee)
, den 25. Se tember 198
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IX) I Abstammungsurkunde.
Cl Bestell-Nr. 14/181 ("Komplett" 7) passend zur Ourchschreibeserie 14/18.
\2 Verlag fllr Standesamtswesen, 6000 Frankfurt am MaIO 1
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114/18'
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