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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Howard s.
Dutchess
Wappinger
1368
123
~ FULL NAME
Nisgor
CURRENT SURNAME
FIRST
MIDDLE
B BIRTH NAME. IF DIFFERENT
v. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
J SDCIAL SECURITY NUMBER
2. RESIDENCEA. New York
(STATEI
~. CHECK ONE = CITY ~ TOWN
~~~CIFY Wappinger
D STREET ADDRESS 41 Alpert Drive ZIP 12590
_. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES ~ NO
3. A. AGE 57 3B. DATE OF BIRTH March /22 /1943
MONTH DAY YEAR
079-34-1683
B. Dutchess
,COUNTY)
VILLAGE
4. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS takeland School Distri
5. PLACE OF BIRTH Brooklyn. New York
(CITY, STATEiCOUNTRY IF NOT USA)
6. FATHER
A. NAME Sidney Nisgor
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Ruth Fishman
S. COUNTRY OF BIRTH USA
B. '<UMBER OF THIS MARRIAGE
Second
9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
One
3. HOW DID LAST MARRIAGE END? 31:] DIVORCE 3\ _ ANNULMENT (2) IX DEATH
v. DATE CAST MARRIAGE ENDED? Feb. / 11 / 1991
MONTH DAY YEAR
J. ARE ANY FORMER SPOUSE(S) ALIVE? = YES X NO
10. iF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATICN
DATE OF DECREE PLACE ISSUED AGAINST WHOM
,MONTH DAY. YEAR) iCITY. STATEiCOUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
1. being duly sworn, depose and say. that
as to my right to enter into the marri e
21 SIGNATURE OF GROOM ~
:]
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24. TOWN 0
.~
{ SEAL }
'-.-'
I
STATE FILE NUMB!:R
(THIS SPACE FOR STATE USE ONLY)
/~~~
L 0 SUPPLEMENTAL FilE
~
11 A. FULL NAME
FROM THE BRIDE
Audrey . H.
FIRST MIDDLE
Bayer
B. BIRTH NAME (MAIDEN NAME!. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIOENCEA. New York
(STATE)
o CITY ~ TOWN 0
Wappinger
D STREETAODRESS 18 Malstorme Road
o CHECK ONE
AND
SPECIFY
:URRENT SURNAME
Gallin
Nisgor
130-46-1695
B. Dutchess
ICOUNT'"
VILLAGE
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE'
13. A. AGE 46 13.B. DATE OF BIRTH May /17
MONTH JAY
ZIP 12590
YES Xl NO
/1954
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Teaching Assistant
t B. TYPE OF INDUSTRY OR BUSINESS Wappingers Cntrl.
15. PLACE OF BIRTH New York. New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
S. COUNTRY OF BIRTH
1B NUMBER OF THIS MARRIAGE
School
Paul Gallin
USA
Evelyn Schechner
USA
Second
19. PREVIOUS MARRIAGES
~. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
Qne
3. HOW DID LAST MARRIAGE END? 13Jt DIVORCE 31 = ~NNc.'.!cNT 2 - DEATH
'v. DATE CAST MARRIAGE ENDED? March / 4 / 1994
MONTH JAY "=>~R
J. ~RE ANY FORMER SPOUSE(S) ALIVE? ~ YES = NO
JEATH
20. F ~REVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOL_:WING iNFORMATION
DATE OF DECREE PLACE ISSUED ~GAINST WHOM
MONTH JAY. YEAR) (CITY. STATEiCOUNTRY. IF 'lOT ~SA' SELF SPOUSE
1ST 3/4/94 New City, New York X;
22 SIGNATURE OF BRIDE ~
A
Deputy Town
DATE
2000
23. SUBSCRIBED AND SWORN TO BEF E ME
SIGNATURE OF TOWN OR CITY RK ~
ThiS license authorizes th marriage in New York ate of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within 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.
CLER~laine H. Snowden, Town Clerk 25. A. SOLEMNIZATION PERIOD BEGINS
by New York Domestic
25. B. SOlEMNlZA TlON PERIOD
=NOS AT MIDNIGHT ON'
MONTH
DAY
YEAR
MONTH
DAY
YEAR
7/27/00 TIME
DATE
NY 12590 AM
STATE ZIP 2:15 PM
27. TYPE OF CEREMONY
,= CIVIL
NAME (PRINT)
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29. OFFICIANT
NAME (PRINT)
SIGNATURE ~
7
28
00
9
25
00
I
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B GOUNTY 'burc.rlfSS
c. LOCATION OF CEREMONY
(CHECK ONE AN.D SPECIFY)
" CITY OF 0 TOWN OF = VILLAGE OF
SPECIFY ~6i(/ I<f.p_p~)~