089
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Ronald V Trammell
MIDDLE CURRENT SURNAME
COUNiY Dutchess
Ci;.<ITO~N WappInger
. 'OIS.tRICT 1388
NUMBER
~G~I~~R 89
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1. A. FUll NAME
FIRST
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B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
D. Sci~I=R~E';U~~~~RSE) 519-98-9091
2. RESIDENCE A. t;wfErork: B. ~
C. CHECK ONE 0 CITY ~TOWN 0 VilLAGE
~IFY Poughkeeplie
D. STREET ADDRESS 115 College Avenue AP- 2 ZIP 12603
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r!I NO
3. A. AGE ".!f7 3B. DATE OF BIRTH MJI /?R / jIIi
4. EMPLOYMENT
A. USUAL OCCUPATION Prqiect Manager
B. TYPE OF INDUSTRY OR BUSINESS I. B. M.
5. PLACE OF BIRTH ~. Idaho
(CITY, STATElCOUNTRY IF NOT USA)
6. FATHER
A. NAME Verlon James Trammell
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME MArIAnA Lot dse stlrr
B. COUNTRY OF BIRTH USA
NUMBER OF THIS MARRIAGE 1
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
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH'
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNUlED, PROVIDE THE FOLlLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTli, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SElF SPOUSE
1ST 0 0
2ND 0 0
3RD 0 0
4TH 0
I, being duly swom, depose and say, that to the best of my knowledge an
as to my right to enter into the ma' estate.
21. SIGNATURE OF GROOM ~
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SIGNATURE ~
MAILING ADDR
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STREET
30. WITNESS TO CEREMONY
NAME (PRINT) /1'1.. r fc
SIGNATURE~ -z...A..
rvu.t..oa 111 JOG\
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STATE ALE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Tati8rui1liAhlmvll
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE TrammP-lI
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. ~TErork B. ~
C. CHECK ONE 0 CITY [)rIl'rOWN 0 VilLAGE
AND Pm .nh-........m
SPECIFY ~.-~-~..........e
D. STREET ADDRESS 115 Callege Avenue AP- 2 ZIP 128fn
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r!I NO
13. A. AGE n 13.B. DATE OF BIRTH -----oo'tit / ~t -1~Q-
14. EMPLOYMENT
A. USUAL OCCUPATION Un. Emplqyed
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH ~1~lfIlnI~d
16. FATHER
A. NAME Vllleriy Venillminovir-h TIAhImv
B. COUNTRY OF BIRTH R.IUtI.
17. MOTHER
A. MAIDEN NAME Rlmml Antonovna Khoh
B. COUNTRY OF BIRTH RI ISSIe
18. 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
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLlLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 0
o 0
o 0
o 0
that no legal impediment exists
0MJ2I20D4
TIME
YEAR
MONTH
ZIP
AM
03:19PM
08
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURR~
A. STATE NEW YORK B. COUN~S'
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF .O/OWN OF ~GE OF
SPECIFY 14/ J1ffl iJ(;{;I(. S ~s
If. c. f7...e;e-"'S r-
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NAME (PRINT)
SIGNATURE ~