047
STATE OF NEW YORK I STATE FILE NUMBER I
] Dutchess (THIS SPACE FOR STA TE USE ONL Y)
COUNTY DEPARTMENT OF HEALTH
CITYfTOWN WappinQer
DISTRICT 1368 AFFIDA VIT, LICENSE and
NUMBER
REGISTER 47 CERTIFICATE OF
NUMBER
MARRIAGE Lo SUPPLEMENTAL FILE ~
FROM THE GROOM FROM THE BRIDE
1. A. FULL NAME John J. Volkmann . Jr. 11. A. FULL NAME Ta~a M 80m
FIRST MIDDLE CURRENT SURNAME FIRST MIDDLE RENT SURNAME
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B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 078-72-5677
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNi'Yj
C. CHECK ONE 0 CITY D~OWN 0 VILLAGE
AND W .
SPECIFY 8Pp,naer
D. STREET ADDRESS 5 Wildwood Manor Apt. 18 A
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
3. A. AGE ")7 38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Mechanic
8. TYPE OF INDUSTRY OR BUSINESS Entergy Nuclear Pawer
5. PLACE OF BIRTH Danbunf.ConriecficlJt
(CITY, STATElOOUNTRY IF NOT USA)
6. FATHER
A. NAME John Volkmann Sr
USA'
8. COUNTRY OF BIRTH _ _ _
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Volkmann
(OPTIONAL. SEE REVERSE) 1 ':11 ,. '" "'':I'''R
D. SOCIAL SECURITY NUMBER _ .::! _ -~g",~.::!~_
12. RESIDENCE A. New Y orlt' B nllt~h~!Ol!Ol
(STATE) . ~'rv)
c. CHECK ONE 0 CITY 0 ~WN 0 VILLAGE
AND W
SPECIFY appinger
D. STREET ADDRESS 5 Wildwood Manor Apt 1R If>
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
13. A. AGE 29 13.8. DATE OF BIRTH no / 1J;
MOrlm" DlI'T"
1'~Qn
YES 0,"",0
/ 1JlZ3
12590
YES a'NO
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7. MOTHER
A. MAIDEN NAME Irene Gambicbler
B. COUNTRY OF BIRTH tIS A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
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(2) 0 DEATH
14. EMPLOYMENT
A. USUAL OCCUPATION Dental A~~i!Olt8nt
8. TYPE OF INDUSTRY OR BUSINESS Irving Baum 0 D. S.
15. PLACE OF BIRTH (fHwm~r<JTNtfW York
16. FATHER
A. NAME .18me~ Anpp
B. COUNTRY OF BIRTH I J S A
17. MOTHER
A. MAIDEN NAME KareR \.lredenburgh
8. COUNTRY OF BIRTH I I S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
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(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
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B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
C. DATE LAST MARRIAGE ENDED?
1ST
2ND
3RD
4TH
I, being duly sworn, depose and
as to my right to enter into the
21. SIGNATURE OF GROOM ~
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, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
dge and belief that the information I provided is true a
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22. SIGNATURE OF BRIDE ~
23. SUBSCRIBED AND SWORN TO BE RE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York authorized
Relations Law ~11 to perform marriage ceremonies wit New 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
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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 >A T THE TIME AND
PLACE INDICATED.
TIME
MONTH
DAY
YEAR
MONTH
YEAR
ZIP
24 2003
04
26
200
06
ATE
27. TYPE OF CEREMONY
o &YAELIGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNTY ~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY ~";.b~~W'rL
29. OFFICIANT
NAME (PRINT)
STATE ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) 5t-o.;fU"7 G Bo r s c...h -:s f' ~
SIGNATURE ~ ~/':2 ~ .........