032
+
ex>
o
LO
C\I
!Z..... I-
W ~ :;
0>- Ill(
~Z Q
~ ~WU::
fi? c ~ u.
~81 Ill(
Om
~Q)t::
liim~
(; ~o
W"'O
~o::
~~
io
~=
15~
~O>
1EC\I
~
W
U
W
a:
W
~
o
o
W
a:
o
o
<
~
u
W
II.
o
w
-0
Z
-w
o
-::i
+
I~~
~~~ w
a:~~ !;(
lii~~ 0
=>ow
::<(.')5 i!
!Z~0l
~~15 ~
lE00 w
~~~ 0
~!l1",
OW
z3~
COUrmQutchess
CITYfTOWNWappinger
~~~:~Rl! 368
~5~I:J~rs2
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Mark Anthony Oberhauser
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
Lo
SUPPLEMENTAL FILE
FROM THE BRIDE
Susan Renee Bidsler
.-J
1. A. FULL NAME
11. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
..
N
B. BIRTH NAME (MAIDEN NAME~f DIFF~RENT
oernauser
C. SURNAME AFTER MARRIAG
(OPTIONAL' SEE REVER~7 { -11-1 bt);j
D. SOCIAL i~1TY NUMBER Dutchess
12. RESIDENCE ~~ B.
(STATE) It/ (COUNTY)
C. ~gC~~hkillD CITY 0 TOWN 0 VILLAGE
SPECI 29 Willow Rd
D. STREET ADDRESS
E. IS RESIDENCE WITHIN LIMITS OF CllY OR INCORPO~!3' VILLAG~ '::t 0
13. A. AG~2 3B. DATE OF BIRTH ~
MONTH DAY
14. EMPLOYMENT ~tudent
A. USUAL OCCUPATIO~ D the 'l
u c eS::i UH II 1IU1 II Y
B. TYPE OF INQLl.STRY_ OR IiUSINE;,Si. t
KocneSter, IVllnneso a
15. PLACE OF BIRTH
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER .
limmy Dean Bldsler
.A. NAM~ L.J SA
B. COUNTRY OF BIRTH
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSEl19 64 5635
D. SOCIAL SECURllY NUMBERt - -
2. RESIDENCE A.NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CI~D TOWN 0 VILLAGE
~~~CIFY Fishkill
D. STREET ADDRE~9 Willow Rd ZIP 125U5
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YEt( 0 NO
11 /17 /1973
MONTH DAY YEAR
12:;08
ZIP 01
~f8 NO
YEAR
3. A. AGF=36
3B. DATE OF BIRTH
~
4. EMPLOYMENT
A. USUAL OCCUPATION Deli Owner
B. TYPE OF INDUSTRY OR BUSINESS1n And Out Deli
5. PLACE OF BIRTHWhite Plains, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Daniel Louis Oberhauser
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Marlene Sally Cappadonna
B. 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
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
r '.~ YEAR
17. MOTHER
Joann Barbara Karau
A. MAIDEN NAME uSA
B. COUNTRY OF BIRTH I
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
~VORCE CIVIL ~NULMENT
~TH
OaTH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
B. HOW DID LAST MARRIAGE END?
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
o 0
o 0
o 0
o 0
that I declare that no legal impediment exists
~
ffi'
III
2
IE
o
:i
tu
w
~
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~H 0 0 ~H
I duly swear/affirm, depose and say, that to th~best f my knowledge and belief that the information I provided is true
as to my right to enter into the ma~ta1"
21. SIGNATURE OF GROOM~ . II~ . SIGNATURE OF BRIDE~
USE CUR N ME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relallons Law ~11to perform marriage ceremonies within New York State. THIS LICENSE VALID tN 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
} NAME (PRINi) Jo C. Mast son
{SEAL SIGNATURE~ C DATE 04/21/2010 TIME MONTH YEAR
'-v-I MA~5GlC1l~d~S sh Rd, Wappingers Falls, NY 12590 03:16~~ 04 22 2010
STREET crrvrrowN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER. .
SONS NAMED ABOVE ON THE 1M A EAR 0 0 RELIGIOUS 1 CIVIL
DATE AND AT THE TIME AND
PLACE IN ICATED. 9 0 OTHER, SPECIFY
06
20 2010
USE CURRENT NAME 04/21/2010
DATE
by New York Domestic
MONTH
YEAR
28. PLACE WHERE MARRIAGE OCCU~ _ _ J. ^
A. STATE NEW YORK B. COU~
C. LOCATION OF CEREMONY
(CHEC~NE AND SPECIFY)
~TY ~OWN OF 0 VILLAGE OF
SPECIFY.:pS:il b fI. k:Sf..i~ f ~
SIGNATURE~