004 23. SUBSCRIBED AND SWORN TO/AFF ED SIGNATURE OF TOWN OR CITY C RK ~ This license authorizes the marriage In New York State of the bride and groom named above by any person authorized RelatiDns 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 CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS } "'"','"on '~~ { SEAL SIGNATURE~ _ r' DATE n1/?R/201 MAILING ADDRESS '-v-I ~ Middleollsh Rd W~r.nin&WrR Fallsh NY 12590 STR 'CITYIT N TATE ZIP ~~~R~~RTr~J 6~O~~N~~E~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY SONS NAMED ABOVE ON THE TI M . Y YEAR 0 fil"RELlGIOUS DATE AND AT THE TIME AND 3 AM PLACE INDICATED. ~ fJtl 9 0 OTHER, SPECIFY + o CJ') ~~ ...-t; >- Z !zC/) wC'll '" '" w a: c c < >- ... ::; JJ :I. 'fl + Z' . 5~~ W ii:t~ ... :ffiz II( gd~ (..) ~~g [L i~ ~ ~~ W III Z; (..) ttj", ~i; STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDA VIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM FIRST~namdi P~![~ck Opar~~SU~~AME COUNTYDlItchess CITYITOWN\^/april"loer ~~J:~c~1368 . ~5~~J~R 4 1. A. FUll NAME .. f:I B. BIRTH NAME. IF DIFFERENT C. SURNAME AFTER MARRIAGE (OPTIONAL. SEE REVERSE) D. SOCIALSECURITYNUMBER 453-91-~??1 2. RESIDENCE A N'(STATE) B. D(bUSS C. CHECK ONE 0 CITY.,LJ TOWN 0 VILLAGE AND \^' . SPECIFY . appmger D. STREET ADDRESS 1 SlIrr~y I ::m~: Apt C ZIP 12590 E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YE9I'tJ NO M~ / ~AQ /~~6 3. A. AGE23 4. EMPLOYMENT A. USUAL OCCUPATION Financial .L\ nalyst B. TYPE OF INDUSTRY OR BUSINESS T echnnlnoy 5. PLACE OF BIRTH ~/!lVj~l~o\JJJvC'F NOT USA) 6. FATHER 3B. DATE OF BiRTH A. NAME Nnamdi Patrick Oparanozie, Sr B. COUNTRY OF BIRTH Nigeria 7. MOTHER A. MAIDEN NAME Teri Lynn lohnsnn B. COUNTRY OF BIRTH I I S L\ 8. NUMBER OF THIS MARF,lIAGE 1 9. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT DEATH o o o 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) (CITYICOUNTY. STATElCOUNTRY. IF NOT USA) SELF SPOUSE 1ST 2ND 3RD 4TH I duly swear/affirm, dep.ose and say, tha as to my right to enter into the marr g 21. SIGNATURE OF GROOM ~ o o o w en z w (..) ::; 29. OFFICIANT NAME (PRINT) SIGNATURE ~ MAILING ADDR f()72 STREET 30. WITNESS TO CEREMONY NAME(PRINT) ~ ~ SIGNATURE~ -A. I STATE FILE NUMBER (THIS SPACE FOR STATE USE ONL Y) L 11. A. FUll NAME o SUPPLEMENTAL FILE FROM THE BRIDE Amanda Bianca Enriauez Perez FIRST MIDDLE CURRENT SURNAME -.J 8. BIRTH NAME (MAIDEN NAME), IF DIFFERENT C. SURNAME AFTER MARRIAGEOparanozie (OPTIONAL. SEE REVERSE}; 56-47 7233 D. SOCIAL SECURITY NUMBER 4 - 12. RESIDENCE ~Y BPutchess (STATE) (COUNTY) C. CHECK ONE 0 CITY..o TOWN 0 VILLAGE AND W . SPECIFY appmger D. STREETADDRESS1 Surrey Lane; Apt C ZIP 12590 o YES~ NO ;t979 YEAR E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 13. A. AGE30 3B. DATE OF BIRTH 03 22 MONTH DAY 14. EMPLOYMENT A. USUAL OCCUPATIONReception B. TYPE OF INDUSTRY OR BUSINESS Insurance 15. PLACE OF BIRTHGalveston. TX (CITY, STATE I COUNTRY IF NOT USA) 16. FATHER A. NAMEEernando Chavez Perez 'B. COUNTRY OF BIRTM S A 17. MOTHER A. MAIDEN NAME Sylvia Renee Enriauez B. COUNTRY OF BIRTM S A 18. NUMBER OF THIS MARRIAGE 1 19. ~~~~~dl~R"g'FR~~~<tT8us MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT n 0 DEATH o B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE 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. STATElCOUNTRY. IF NOT USA) SELF SPOUSE (3) 0 ANNULMENT (2) 0 DEATli / / .-- YEAR 1ST 2ND 3RD 4TH that the information I provided Is tr o o o TIME MONTH YEAR MONTH YEAR , AM 12:41PM 01 27 2010 03 27 2010 28. PLACE WHERE MARRIAGE OCCURRED 10 CIVIL A. STATE NEW YORK B. COUNTY C. LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) o CITY OF ~OWN OF 0 VILLAGE OF SPECIFY B15r h$HI{Il-1- / Z{)3, ZIP ". WITH'SS =%""' NAME (PRINT) U\~:\- '{Y\ 1::l'=:lV"e.... SIGNATIJRI=. (1 lA.t\ .L.l..ifY\ C'\.ct\ C\