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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
jose~afer:i.lncis LUN~MRNAME
1ST 0 0 1ST
2ND 0 0 2ND
~ 0 0 ~
4TH 0 0 ~H
I duly swear/affirm, depose and say, that to the best of my knowledge and belief that the informatioh I provided is true and t
as to my right to enter into the mama state. 4' /
21. SIGNATURE OF 6ROOM~ ' 22. SIGNATURE OFBRIDE~
USEC
BEFORE ME
23. SUBSCRIBED AND SWORN TO/AFFIRM
SIGNATURE OF TOWN OR CITY CLER
This license authorizes the marriage in New York State 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.
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
COUNTY Dlltchess
CITYrrOWN Wappinger
~~~~~c~ 1 368 .
~5~1:~~R 88
1 . A. FULL NAME
FIRST
I
STATE FILE NUMBER
(TH/S SPACE FOR STATE USE ONL Y)
I
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
D. SOCIAL SECURITY NUMBER 124-68-2263
2. RESIDENCE A. NV B. f"\, '+f'heSi
(STATE) ~
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND n 1-,,1, .
SPECIFY rougll",e~pSle
D. STREET ADDRESS 29 lI(;1rrnw PI::lr.p ZIP 1 ?Rn~
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES \ZJ NO
3. A. AGE 25 3B. DATE OF BIRTH MO;JrP / ~ / y1j83
4. EMPLOYMENT
A. USUAL OCCUPATION Fin~ncial An~IYit
B. TYPE OF INDUSTRY OR BUSINESS Syndic::ltel na,.,r.nl~ino
5. PLACE OF BIRTH ~Q~ !~~~totrPr~)~ No~u~~f' Y orl<
6. FATHER
A. NAME Josilph Fr~ncii Lentz III
B. COUNTRY OF BIRTH I I S A
7. MOTHER
A. MAIDEN NAME Linda ~Io C"rroll
B. COUNTRY OF BIRTH I J S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
o
o
(2) 0 DEATH
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Ht:>It:>n ,^, I:lllano...
., 1m!:!: OfIRRENT SURNAME
-.J
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
11. A. FUll NAME
FIRST
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
~
{ SEAL }
'-v-I
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. sV~~~~~~~~~t~W~~~st;lu~ng Lentz
D. SOCIAL SECURITY NUMBER 1 ??-RR-n4??
12. RESIDENCE A. NY B. DVt,..ht:>SS
(STATE) \~
C. CHECK ONE 0 CITY 12I TOWN 0 VILLAGE
AND P hk .
SPECIFY nllO ppr~IP
D. STREET ADDRESs3~n6 Cherry Hill Dr ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES ~ NO
13. A. AGE 24 3B. DATE OF BIRTH 2~TH A gAY -1 ~J1~
14. EMPLOYMENT
A. USUAL OCCUPATION T e~nher
B TYPE OF INDUSTRY OR BUSINESS Mandarin Teacher
15. PLACE OF BIRTH OIIPpn~ Npw Y nrk
(CITY, STATE /COUNTRY IF NOT USA)
16. FATHER
A. NAME Slle-1ng 1-l11~ng
'B. COUNTRY OF BIRTH T a iwa n
17. MOTHER
A. MAIDEN NAME May-Min Wang
B. COUNTRY OF BIRTH T a iwa n
18. NUMBER O.F THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
n n
DEATH
n
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. - YEAR
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) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
o 0
o 0
o 0
o 0
I. re that no legal.impediment exists
~
08/19/2009
by New York Domestic
TIME
MONTH
NAME (PRINT)
29. OFFICIANT
NAME (PRINT)
NAME (PRINT)
SIGNATURE~
YEAR
MONTH
YEAR
AM
02:58PM
08
20
2009
10
18 2009
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY o./' fc.h ~>..>
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY ~c-(PPr~C'/5
NAME (PRINT)
SIGNATURE~