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B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
New York B
(STATE) ,COUNTY)
C CHECK ONE [] CITY ~ TOWN L VILLAGE
~~~CIFY Poughkeepsie
D. STREET ADDRESS 18 Marino Road
COutyY
CITYnio)WN
DISTRICT
NUMBER
REGISTER
NUMBER
51 A 1E OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christopher Neil
FIRST MIDDLE
Dutchess
Wappinger
1368
135
1. A. FULL NAME
Ostlie
t 1. A. FULL NAME
CURRENT SURNAME
0..
N
B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE 1
D. SOCIAL SECURITY NUMBER
New York
(STATE)
C. CHECK ONE c::: CITY ~ TOWN VILLAGE
~~~CIFY Poughkeepsie
D. STREET ADDRESS 18 Mar i no Ro ad ZIP 1260 1
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES Xi NO
Sept. / 17 /1975
MONTH DAY YEAR
2 RESIDENCE A.
501-98-9036
Dutchess
(COUNTY)
12. RESIDENCE A.
B.
I
STATE ALE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
/ i,-",Ic V
~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Melissa Ann
~
Masten
FIRST
MIDDLE
CURRENT SURNAME
Ostlie
054-60-9382
Dutchess
ZIP
12601
3. A. AGE
24
38. DATE OF BIRTH
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
13. A. AGE 25 13.8. DATE OF BIRTH May /10
MONTH DAY
YES X:: NO
/1975
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION
United States Marine Corp.
14. EMPLOYMENT
A. USUAL OCCUPATION
United States Marine Corp.
B. TYPE OF INDUSTRY OR BUSINESS
5. PLACE OF BIRTH Northwood, North Dakota
(CITY. STATE'COUNTRY IF NOT USA)
8. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Mount Kisco, New York
(CITY. STATE-COUNTRY IF NOT USA)
6. FATHER
A. NAME Neil Douglas Ostlie
8. COUNTRY OF BIRTH North Dakota. USA
7. MOTHER
A. MAIDEN NAME
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
18. NUMBER OF THIS MARRIAGE
B. COUNTRY OF BIRTH
Suzann Lorie Berthold
North Dakota, USA
First
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
Stephen Masten
USA
Nancy Snowdon
USA
First
DEATH
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? (3\ C DIVORCE
C. DATE LAST MARRIAGE ENDED?
131 0 ANNULMENT
/ /
(2) c::: DEATH
MONTH DAY YEAR
D ARE ANY "ORMER SPOUSE(S\ ALIVE? = YES = NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY. YEAR\ iCITY. STATE COUNTRY. IF NOT USA) SELF SPOUSE
8. HOW DID LAST MARRIAGE END? (31 [J DIVORCE 31 = ANNULMENT
C. DATE LAST MARRIAGE ENDED? / /
MONTH )A Y YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? = YES = NO
20. IF PREVIOlJSLY DIVORCED OR ANNULED. PROVIDE -HE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. ~AY. YEARI (CITY. STATE:COUNTRY. IF '<OT USA' SELF SPOUSE
23. ~::;A~~~~DO~NT~~~OO~ 6'ivBg~~~. E , DATE Aug. 11, 2000
This license authorizes the marriage in New York Sta of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within 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 CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
Elain Town Clerk
1ST
2ND
3RD
4TH
I. being duly sworn, depose and say, tha
as to my right to enter into the marria
21 SIGNATURE OF GROOM.
o
.0
w
en
z
w
o
::i
~
{ SEAL }
'-.t-I
NAME (PRINT)
DATE 8/11/00
NY 12590
SIGNATURE.
MAIL1NG~DDRE
pu .!SOX
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
. 9 0 OTHER. SPECIFY
29. OFFICIANT
NAME (PRINT)
NAME (PRINT)
SIGNATURE.
OOH-98 (1198)
NAME (PRINT)
SIGNATURE.
,21 = DEATH
diment eXists
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
AM
ZIP 1 :00 PM
l~'VIL
10
00
8
00
10
12
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY D u,J (IN <;~
C. LOCATION OF CEREMO)#r'
(CHECK ONE ANrCIFY)
o CITY OF iP'r'OWN OF .:: VILLAGE OF
SPECIFY WlA- P~I Al6f,~