136
A. FULL NAME
51 A 1E OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
William Peter
FIRST MIDDLE
FROM THE BRIDE
Sabrina Daniela Birgid Gasslein
FIRST MIDDLE CURRENT SURNAME
(THIS SPACE FOR STATE USE ONL Y)
COUNTY Dutchess
~o'v"~' Wappinger
~~~:fRT" 1368
~~~I~J~R 136
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L 0 SUPPLEMENTAL FILE
~
Nagwak
CURRENT SURNAME
11 A. FULL NAME
B BIRTH NAME. IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
,OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMR<C
12. RESIDENCE A. -. Germany
(STATE)
o CITY Xi TnWN
Urfersheim
2.0 JJrfersheim
ZIP
Nagwak
n/a
C SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
o SOCIAL SECURITY NUMBER
2 RESIDENCE A Kentucky B Christian
iSTAJ~) iCOUNTY)
" CHECK ONE I2Il CITY :: TOWN :1 VILLAGE
~~~CIFY Fort Campbell
8-101 AVN
019-62-2509
-rllesheim
,COUNTY)
VILLAGE
B.
C. CHECK ONE
~ND
SPECIFY
91471
42223
D. STREET ADDRESS
D. STREET ADDRESS
ZIP
YES X:J NO
/1980
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE'
13. A. AGE 20 13.B. DATE OF BIRTH Feb. / 8
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? !Xl YES 0 NO
3 A. AGE 23 3B DATE OF BIRTH May / 4 /1977
MONTH DAY YEAR
MONTH DAY
14. EMPLOYMENT
4. EMPLOYMENT
A. USUAL OCCUPATION Student
B. TYPE OF INDUSTRY OR BUSINESS Germany
15. PLACE OF BIRTH Lichtenfels , Germany
(CITY. STATE/COUNTRY IF NOT USA)
A. USUAL OCCUPATION Mili tary
B. TYPE OF INDUSTRY OR BUSINESS U . S. ArmY
5. PLACEOFBIRTH Cortlandt. New York
(CITY. STATE,COUNTRY IF NOT USA)
16. FATHER
A. NAME Karl Heinz Gasslein
B. COUNTRY OF BIRTH Germany
17. MOTHER
6. FATHER
A NAME Walter Nagwak
B. COUNTRY OF BIRTH USA
, MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
A. MAIDEN NAME Renate Elisabeth
B. COUNTRY OF BIRTH Germany
First
Panzer
Kathleen Campbell
USA
First
18. NUMBER OF THIS MARRIAGE
8. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
81VORCE CIVIL ANNULMENT
DEATh
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END' (3) u DIVORCE
C. DATE LAST MARRIAGE ENDED?
3) = ANNULMENT
/ /
(2) 0 DEATH
2\= DE:~ ::-1
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? = YES = NO
. 0 IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) 'CITY. STATEiCOUNTRY. IF NOT USA) SELF SPOUSE
B. ~CW DID LAST MARRIAGE END? !31 C DIVORCE 3\ = iNNULMENT
C wATE cAST MARRIAGE ENDED? / /
MONTH :)A" "EAR
D ~RE ANY FORMER SPOUSE(S) ALIVE? = YES NO
20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE cCLcOWINGNFORMATON
JATE OF DECREE PLACE ,SSUED ~GA,NST WHCM
MONTH DAY. YEAR) (CITY. STATE'COUNTRY IF NOT USA' SeLF SPOUSE
1ST
2ND
3RD
4TH
I. being duly sworn, depose and say, that to the best of my kno
as to my right to enter into the marriage tate.
21 SIGNATURE OF GROOM ~
[J 1ST
C 2ND
[] 3RD
o 4TH
and belief that the iniDrmanon I provided is true an
DATe
Aug. 14, 2000
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23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York ate of the bride and groom named above by any person authorized
Relations Law 911 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
:= 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 (PRINTG) Ela1.YEf ~ Snowden, Town Clerk TIME MONTH DAY YEAR
SIGNATURE ~Olll.l!! ~~Ah.~t,... DATE 8/14/00
MAILlNG~eP'OX 324, Wappingers Falls, NY 12590 10:00AM 8 15 00
STREE I WN S A ZIP PM
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR RELIGIOUS 1 CIVIL
DATE AND AT THE TIME AND
PLACE INDICA TED.
10
13
00
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENOS AT MIDNIGHT ON:
~
{ SEAL }
'-.t-I
MONTH
DAY
YEAR
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~
C. LOCATION OF CEREMONY
(CHECK ONE AND PECIFY)
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OTHER. SPECIFY
29. OFFICIANT
NAME (PRINT)
SPECIFY
NAME (PRINT)
SIGNATURE ~
DOH-98 (1198)