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~ I A II: UI- NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Rob~Jv1iohool ~~~SURNAME
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say, t at to he best of ~nowl
as to my right to enter into the mama sta.
21. SIGNATURE OF GROOM~
NTN E
23. SUBSCRIBED AND SWORN TO/AFFIRMED B
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New rk 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 Dutchess
CITYfTOWN '^'appinger
DISTRICT . .
~~~I~~~~ 368
NUMBER 1 34
1. A. FULL NAME
FIRST
..
N
8. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 07 Q 70 -1 Q 7 0
2 RESIDENCE A NYSTATE) B. qMthm~ss
C. CHECK ONE 0 CITY $J TOWN 0 VILLAGE
AND
SPECIFY Wappinger
D STREET ADDRESS 30 8 Dorothy Heights Road ZIP 12590
E. IS RESIDENCE WI1liIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YESolJ NO
3. A. AGE 31 3B. DATE OF BIRTH MO~~ / ao / W6
4. EMPLOYMENT
A. USUAL OCCUPATION /\sGist::mt Property Manager
B. TYPE OF INDUSTRY OR BUSINESS Property M.magement
5. PLACE OF BIRTH ("nrl:l<:>n,;t I\h/
"tt51TY. ~OWu/il'RIV IF NOT USA)
6. FATHER
A. NAME Riohard Arthur Booth Jr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Jane Milrie VVhite
B. COUNTRY OF BIRTH USA-
6. 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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
STATE FILE NUMBER
(TH/S SPACE FOR STA TE USE ONL Y)
"I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Angeli~~ily Lang~~T SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE !:looth
(OPTIONAL - SEE REVERS'E!
o SOCIAL SECURITY NUMBER 061-67 -919A.
12. RESIDENCE ANY B.D'ltr-h",SS
(STATE) 'TC'tlI'lm-v;
C. CHECK ONE 0 CITY oil] TOWN 0 VILLAGE
AND \AI .
SPECIFY applnger
D. STREET ADDRESS.~n R nnrnthy HAight!=; Road ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
~dNTH ~ty ,,{~ll
13. A. AGE 30
14. EMPLOYMENT
A. USUAL OCCUPATION UndenMriting Assistant
B. TYPE OF INDUSTRY OR BUSINESS In!=;1 Jr::lnr.A
15. PLACE OF BIRTH Bellern!::p(j Nv
(CITY, STATE / C UNTRV IF NOT USA)
16. FATHER
3B. DATE OF BIRTH
.A. NAMEGregory Langone
B. COUNTRY OF BIRTHI , ~ A
17. MOTHER
A. MAIDEN NAME Ii Idith Ann 7imhArlin
B. COUNTRY OF BIRTHI , S A
18. NUMBER OF THIS MARRIAGE 1
19. 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
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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. - YEAR
1ST
2ND
3RD
4TH
that e information I provided is t
~
{ SEAL }
'-.t-'
NAME (PRINT)
o
o
o
2. GNATURE OF BRIDE ~
by New York Domestic
TIME
09 2008
STR ITY WN
~~~R~~RT~~J IO~O~~~N~ZEEf. 26. SOLEMNIZATION OCCURRED
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR
DATE AND AT THE TIME AND 'lilrM
PLACE INDICATED. ~ PM C<.:\ - l'7 O:ii
29. OFFICIANT ~ :1>cmo.lc;.. w' ~QYl<::lY"'d..e>
NAME (PRINT) __
SIGNATURE~ (:. ~CD. (
MA~~A~~S A-(~~J ~cl, ~~
STREET ' CITYfTOWN
3D WITNESS TO CEREiNY ,\:}-J-I-
II - 1 iO " '='~ \ ''''"
NAME (PRINT) :,:~v V\=-'~~~ ___
SIGNATURE~ r!t'~
DOH-98 (D3/2oo6)
MONTH
YEAR
MONTH
YEAR
DATE
AM
05:35PM
09
11
2008
11
STATE
27. TYPE OF CEREMONY
o l)iI RELIGIOUS
9 0 OTHER. SPECIFY
TITLE R.c. ~y I~:t
DATE O:,st-. \1, 2.00'8
N '<... l D$""l (.
STATE
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LLAGE OF
SPECIFY ~~
SIGNATURE~