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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Erik T. Pahl
COUN~utchess
CITYITOWNVl!appinger
~~~~kcR136B
~o~I~J~R165
1. A. FULL NAME
CURRENT SURNAME
I
I
FIRST
MIDDLE
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
.~ II
{)t?ft{;' M'-J 1- d ~
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Katrina J. Hobbs
~
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
D. Sci~I~~I~~t~R;T~E~U~~~~RSElJ 17-66-5906
2 RESIDENCE ANew York B Dutchess
(STATE) ..L. (COUNTY)
C. CHECK ONE 0 CITY -U TOWN D VILLAGE
~~~CIFY Pouahkeepsie
D. STREET ADDRESS2 Argent Drive
ZIP 11603
....
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES D NO
08 /31 /1976
DAY YEAR
3 A AG~6
38. DATE OF BIRTH
MONTH
11. A. FULL NAME
FIRST
CURRENT SURNAME
4. EMPLOYMENT
A USUAL OCCUPATION Corrections Officer
8. TYPE OF INDUSTRY OR BUSINEssState Law Enforcement
5. PLACE OF BIRTHCatskill, New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME Norbert Pahl
8. COUNTRY OF BIRTH Germ any
7. MOTHER
A MAIDEN NAME Karin Erdmann
8. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Palll
(OPTIONAL. SEE REVERSE2~ 1-2~-2767
D. SOCIAL SECURITY NUMBER ~ k
12. RESIDENCE ANew York B Dutchess
(STATE)...t. (COUNTY)
c. CHECK ONE 0 CITY D TOWN D VILLAGE
~~~CIFyPoughkeepsie
D. STREET ADDRES,f Argent Urtve
ZIP 1 ltiUJ
vi
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES D NO
,.,lS Y9 74
13. A. AGE28
QS
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
(3) D ANNULMENT
/ /
(2) D DEATH
13.8. DATE OF BIRTH
DAY
YEAR
C. DATE LAST MARRIAGE ENDED?
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATIONCorreGtiom: Officer
B. TYPE OF INDUSTRY OR BUSINESS~late Law Enforcement
15. PLACE OF BIRTHNorwich, Connecticut
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Charles Hobbs Jr.
B. COUNTRY OF BIRTJ.! S A
17. MOTHER
A. MAIDEN NAME Dorothy Boudah
B. COUNTRY OF BIRTJ.1 S A
1 B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DOORCE CIVIL A~ULMENT
DEATH
n
U
8. HOW DID LAST MARRIAGE END? (3) D DIVORCE
(3) D ANNULMENT
/ /
(2) D DEATH
C. DATE LAST MARRIAGE ENDED?
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
D D 1ST D D
D D 2ND D D
D D 3RD D D
D D 4TH D D
be t of my knowledge and belief that the information I provided is true and that I declare th~ nJ leg;}imj1diment exists
~ 22.SIGNATUREOFBRIDE~ .~ I ~
U E CU T NAME Jf t;l USE CURRENT NAME
10/04/2002
DATE
by New York Domestic
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/9B)
1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, that t~
as to my right to enter into the marriage sta~
21. SIGNATURE OF GROOM ~
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YEAR
1 D CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY\)\:i -\ J{.s ~
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29'OFFICIAN~C ~. \ ~. ;. J _ \ d
NAME (PRINT) .. .~ TITLE ~ 11$\ ~ \ ~f 52
SIGNATURE~ __ _~ DATE Ic>-15-@
MAILING ADD . ~
/ 5'4/ l;l){ r 120 ^) ~ ..om j} ~. ^ /~ (je(l, t Lt {J (b
STREET · CITYi'ibWN' . STAT ZIP
30. WITNESS TO CEREM
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York authorized
Relations Law ~11 to perform marriage ceremonies wi n New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
D If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24 TOWN OR CITY CL!,RK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Glon J
{TIME MONTH
SEAL MSIGNATURE ~
'-v-I lcrMfcf~, 08:41 AM 10
~~ ~ ~
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABDVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
C. LOCATION OF CEREMONY
(CHECK ONE AND ~CIFY)
D CITY OF ~WN OF D VILLAGE OF
SPECIFY ~\..)~ \-<rq~Q \'
NAME (PRINT)
SIGNATURE ~