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114 + W f- ;0 '<:!"It) N L{') N ~ ~ ~>- >- '\JZ w <C ~= e 5~wl.L 0..c"1.L ~ cn~ <C ZU::~ B ~ ~ Q) I::: t;; >~ a'cu tJ!o w (0 ... a: 0:: ... :; u. o LU f- ... u LL ;:: 0:: LU U LU 0:: LU I ;: It) It) LU 0:: '" '" ... ~ 13 LU 0- (/J + ~~~ W tu~~ ~ 0::0::_0 <C t;;~~ U =>O~ _ :; (00 I.L ~~(I) - ",:Ou. ~ Q~O a: ~g~ w w~~ (,) 5~'" Z~~ ~ I"'"' I a;;;;. vr I~~ VV 'VM"- DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM las~Ddosiah Ba'el~~~ SURNAME COUNTY n'ltr.hp.ss CITYfrOWN W::lppingp.r ~~~:~CRT 1 ~RR ~~~I;;~R 114 1 . A. FULL NAME FIRST 0- N B. BIRTH NAME, IF DIFFERENT C. SURNAME AFTER MARRIAGE (OPTIONAL. SEE REVERSE) D. SOCIAL SECURITY NUMBER 1 :i4-7?-11 ~R 2. RESIDENCE A N'lsTATE) B. q!!t~:P)E"S" C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE ~~~CIFY Fishkill D. STREET ADDRESS 1025 Dutcher Drive ZIP 12524 E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES ~ NO 3. A. AGE 26 3B. DATE DF BIRTH MO~ / ~~ / ~E~R82 4, EMPLOYMENT A. USUAL OCCUPATION GO\ll'lrl1ml'lnt Cnntr::lr.tnr B. TYPE OF INDUSTRY OR BUSINESS Govp.rnmp.nt 5. PLACE OF BIRTH North Hp.mn~tp.::ld Ny (CITY, STATE / COUNTRY IF NOT USA) 6. FATHER A. NAME Gre>gory Ste>"I'ln R::llltist::l B. COUNTRY OF BIRTH LJ S A 7. MOTHER A. MAIDEN NAME I ::lllr::l Rosp. Acarnn B. COUNTRY DF BIRTH l J S A 8. NUMBER OF THIS MARRIAGE 1 9. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT o n 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 (THIS SPACE FOR STATE USE ONL Y) L 0 SUPPLEMENTAL FILE FROM THE BRIDE K::ltrin::l .Jamp.s Rauff MIDDLE CURRENT SURNAME 11. A. FUll NAME FIRST B. BIRTH NAME (MAIDEN NAME), IF DIFFERENTR::lllff-I\JIi Isser C. SURNAME AFTER MARRIAGE R::lllti~t::l (OPTIONAL. SEE REVERSE)200 64 6375 o SOCIAL SECURITY NUMBER ___ - _ - 12. RESIDENCE A NY BDutchp.ss (STATE) (COUNTY) C CHECK ONE 0 CITY ~ TOWN 0 VILLAGE ~~~CIFY Fishkill D. STREET ADDRESS 1025 Dutcher Drive 14. EMPLOYMENT A. USUAL OCCUPATION Compensation Analyst B. TYPE OF INDUSTRY OR BUSINESS Finance 15. PLACE OF BIRTH Centre Pennsylvania (CITY, STATE / COUNTRY IF NOT USA) 16, FATHER A NAME Rodnp.y Earl Musser 'B. COUNTRY OF BIRTHU S A 17. MOTHER A. MAIDEN NAME Yvette Louise Rauff B, COUNTRY OF BIRTHU S A 18. NUMBER OF THIS MARRIAGE 1 19, PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT o 0 ZIP 12524 DYES '6 NO A~83 YEAR E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 13, A. AGE?!; 3B. DATE OF BIRTH 04 A? MONTH DAY DEATH o B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH / / - YEAR 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 a: w '" :; :0 Z C Z ... f- W W a: f- (/J 1ST 0 0 1ST 2ND 0 0 2ND 3RD 0 0 3RD 4TH 0 0 4TH I duly swear/affirm, depose and say. that to the best of my knowledge and belief that the information I provided is true and that I declare t as to my right to enter into the marnage state, ;.-- o 0 o 0 o 0 o 0 t no legal impediment exists 23. SUBSCRIBED AND S RN TO/AFFIRMED BEFO E SIGNATURE OF TO.WN 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 ~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 w en z w (,) ::; ~ { SEAL } '-v-I NAME (PRINT) 22. SIGNATURE OF BRIDE~ DATE 08/22/2008 by New York Domestic TIME MONTH YEAR MONTH YEAR DATE 08/22/2008 In ers Falls NY 12590 ITV WN STATE ZIP 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ,/ TIME MO, DAY YEAR 0 0 RELIGIOUS 1 It' CIVIL 0'" ~ " I;.ot" 9 0 OTHER, SPECIFY 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 ) C H /II 1-1 -:tlS; 1= '-PJ NAME (PRINT) - . _----=- SIGNATURE~ d.. I( '/"- MAILING ADDRESS 7~---- 2/ GVRlO ST. N'I,Al..1( STREET CITYfrOWN 3D. WITNESS TO CEREMONY AM 02:46PM 08 23 2008 10 21 2008 28. PLACE WHERE MARRIAGE OCCURRED A, STATE NEWYORK B,COUNTY (b'-l(l/JJV>> J\i ~'t~ R DATE"" S.e Pr: l..~jY M3t...1 'r~1(1(. STATE C. LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) o CITY OF 0 TOWN OF D-'t1tLAGE OF SPECIFY N'~ 4- (.1<' TITLE N't NAME (PRINT) SIGNATURE~ DOH-9B (03/2006) NAME (PRINT) SIGNATURE~