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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Paul GeorQe VOQeIsang
MIDDLE CURRENT SURNAME
COUNTY [)~
CITY/TOWN Wappinger
1368
23
DISTRICT
NUMBER
REGISTER
NUMBER
1. A. FULL NAME
FIRST
"-
N
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) O:7":)":)D 7564
D. SOCIAL SECURITY NUMBER I J'"JU'"
2. RESIDENCE A New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~OWN 0 VILLAGE
~~~CIFY PoughkeeDBie
D. STREET ADDRESS 17 Monroe Drive
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE 43 3B. DATE OF BIRTH 05 /
MONTH
liP 12601
DYES o"'NO
08 / 196
DAY YEAR
4. EMPLOYMENT
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A. USUAL OCCUPATION Fence Installer
8. TYPE OF INDUSTRY OR BUSINESS A-1 Fence Co.
5. PLACE OF BIRTH Pouah~e. New York
(CITY, ST~CO~ NOT USA)
6. FATHER
A. NAME Hubert Vogelsang
8. COUNTRY OF BIRTH Germany
7. MOTHER
A. MAIDEN NAME I. Krump:
8. COUNTRY OF BIRTH Germany
B. NUMBER OF THIS MARRIAGE 2'
l-
S;
DEATH
o
(2) 0 DEATH
1999
YEAR
1ST
2ND
3RD
4TH
I, being duly sworn, depose and
as to my right to enter into the
21. SIGNATURE OF GROOM"
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{ SEAL}
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NAME (PRINT)
STREET
I CERTIFY THAT I SOlEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
28. OFFICIANT
NAME (PRINT)
SIGNATURE ..
MAILING ADDRESS
76 hGN.
STREE
30. WITNESS TO CEREMONY
DATE
NAME (PRINT)
SIGNATURE ..
DOH.98 (11/98)
'ill if
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L D Sr;pPLEMENTAL FILE
I
-1
FROM THE BRIDE
Rita Jane Peragallo
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Donohue
C. SURNAME AFTER MARRIAGE VOQeIsang
(OPTIONAL. SEE REVERSE) IVYl C"\ 5429
D. SOCIAL SECURITY NUMBER U;:J..:.-U..:.-..:.
12 RESIDENCE A. New Y ol1c B. Dutchess
(STATE) J (COUNTY)
C. CHECK ONE 0 CITY 0 "'"TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D STREET ADDRESS 17 Monroe Drive
11. A. FULL NAME
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
10 / 16
MONTH DAY
13. A. AGE 42
13.8. DATE OF BIRTH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) 0 ~VORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 12/ 08 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? D.tS 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
12JDB11999 Pough~e, New York 0" 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
ge and belief that the information I provided is tru
14. EMPLOYMENT
A. USUAL OCCUPATION Dental Assistant
B. TYPE OF INDUSTRY OR BUSINESS Dr. Ray Neville
15. PLACE OF BIRTH Manhattan. New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Lerov Martin Donohue
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Rita Jane Barrett
B. COUNTRY OF BIRTH USA
2
18. NUMBER OF THIS MARRIAGE
18. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
liP
12601
YES D"'NO
/1962
YEAR
DEATH
1
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 t"TH
C. DATE LAST MARRIAGE ENDED? 03/ 17 / 1997
MONTH QII,Y YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 'I'Ilo
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
22. SIGNATURE OF BRIDE ..
TIME
MONTH
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York St e of the bride and groom named above by any person authorized by New YDrk 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 fDr the purpose of a secDnd or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
ZIP
AM
03:01M
04
2B. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF WTOWN OF 0 VILLAGE OF
SPECIFY CO r m (, I
o
o
o
YEAR
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