025
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23. SUBSCRIBED AND SWORN TO/AFFIRMEDBEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11to 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
{ } NAME (PRINT) John C. Masterson
TIME MONTH YEAR
SEAL SIGNATURE ~ DATE 04/17/2009
MAILING ADDRESS
'-y-I 20 Middleb h Rd, WappinQers Falls, NY 12590
STREET CITY/TOWN STATE ZIP
~~~R~~RT~~~ 10~O~~~N~zEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ../
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 00 RELIGIOUS 1 !B'CIVIL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Kesho Motilall Dukhram
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITY/TOWN Wappinger
~~~~~c~1368
~~~~;~R25
1. A. FULL NAME
FIRST
..
N
S. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)11 0 56 2387
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. NJ s. Berqen
(STATE) (COUNTY)
C. CHECK ONE 0 CITY"\J TOWN 0 VILLAGE
~~~CIFY Mahwah
D. STREET ADDRESS 2303 Rio Vista Drive ZIP 07430
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES.....O NO
3. A. AGE34 3B. DATE OF BIRTH 01 /03 /1975
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Account Manaqer
B. TYPE OF INDUSTRY OR BUSINESS Medical Sales
5 PLACE OF BIRTH Suffern, New York
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Chatterpaul Dukhram
B. COUNTRY OF BIRTH Guvana
7. MOTHER
A. MAIDEN NAME Janet Hansraj
B. COUNTRY OF BIRTH Guvana
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
o
o
o
21. SIGNATURE OF GROOM~
29. OFFICIANT
NAME (PRINT)
NAME (PRINT).
SIGNATURE~
DOH.QR IO~/?nnR\
::itAII: t"ILt: NUMtU:H
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Tania Saini
~
11. A. FULL NAME
CURRENT SURNAME
FIRST
MIDDLE
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANJ
(STATE) wL
C. CHECK ONE 0 CITY U TOWN 0
~~~CIFYMahwah
D. STREET ADDRESf303 RIO Vista lJnve
xxx-xx-xxxx
sBergen
(COUNTY)
VILLAGE
U/4::SU
ZIP
.t.
o YES 0 NO
)973
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A AGE35 3B. DATE OF BIRTH 05 )'4
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Garment Business
B. TYPE OF INDUSTRY OR BUSINESS Fashion
15. PLACE OF BIRTH New Delhi, India
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAMEBalbir Singh Saini
'B. COUNTRY OF BIRTJndia
17. MOTHER
A. MAIDEN NAME Basanti Saini
B. COUNTRY OF BIRTJndia
1B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT (2) 0 DEATH
/ /
, - YEAR
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
o
o
1ST
2ND
3RD
o
o
o
o
o
o
DATE
04/17/2009
by New York Domestic
MONTH
YEAR
01:10~~ 04
18
2009
06
16 2009
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY q;J\ilc.lf-U!R
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
~ OF 0 TOWN OF 0 VILLAGE OF
B"2(.f-C.,,~
SPECIFY
NAME (PRINT)
SIGNATURE~