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067 ~-- Q. N + >- Z W UJ W III O. ...J => o J:: UJ Z o ~ t;; Ci W 0:: W ~ it: 0:: <[ :;; u.' o w-. !;( c,). ii: ~ w C,) W 0:: W ~ UJ UJ W 0:: o o <[ ~ u W Q. UJ Iii w 0:: Ii; w en z w 0 ::i + ~~~ W =>-- tii~~ ~ c:~_ c:t >-wz 0 UJ..J:;; =>C,)W :;;C!l5 u:: !Z~UJ i= ~~t5 a: ttou> w 0>-> 0 IijlllCS ...z'" o~z Z::i_ 1. ,A. FULL NAME STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM FIRST Ant~?oQ.~ Talbert ~~~E~SSURNAME I STATE FILE NUMBER (TH/S SPACE FOR STATE USE ONL Y) I COUNTY Dutchess CITYfTOWN WappinQer ~~~~c~ 1368 . ~5~1;~~R 67 -1 L 0 SUPPLEMENTAL FILE FROM THE BRIDE Michele Orlando MIDDLE CURRENT SURNAME 11. A. FUll NAME FIRST B. BIRTH NAME, IF DIFFERENT B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT C. SURNAME AFTER MARRIAGE Jones (OPTIONAL. SEE REVERSE) 101-76-1075 D. SOCIAL SECURITY NUMBER 12. RESIDENCE A. New Yark B. Dutchess (STATE) (COUNTY) C. CHECK ONE 0 CITY ~ TOWN 0 VilLAGE ~~~CIFY Wappin9.er D. STREET ADDRESS48 Park Hill Drive ZIP 12533 E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES '6 NO 09 /22 ;t'979 DAY YEAR C. SURNAME AFTER MARRIAGE (OPTIONAL. SEE REVERSE)074 72 3474 D. SOCIAL SECURITY NUMBER -- 2. RESIDENCE A. New York B. Dutchess (STATE) (COUNTY) C. CHECK ONE 0 CITY ~ TOWN 0 VilLAGE ~~CIFY WappinQer D. STREET ADDRESS 48 Park Hill Drive ZIP 12533 E. is RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES '6 NO 03 / 26 / 1976 MONTH DAY YEAR 13. A. AGE 27 3. A. AGE 31 3B. DATE OF BIRTH 3B. DATE OF BIRTH MONTH 4. EMPLOYMENT A. USUAL OCCUPATION Truck Driver B. TYPE OF INDUSTRY OR BUSINESS Taylor Recycling 5. PLACE OF BIRTH Danbury, Connecticut (CITY, STATE I COUNTRY IF NOT USA) 6. FATHER A. NAME Andrew Thomas Jones Sr. B. COUNTRY OF BiRTH USA 7. MOTHER A. MAIDEN NAME Mary Ellen Catherine 0' Connell B. COUNTRY OF BIRTH USA B. NUMBER OF THIS MARRIAGE 1 9. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DiVORCE CIVIL ANNULMENT o 0 14. EMPLOYMENT A. USUAL OCCUPATION Unemployed B. TYPE OF INDUSTRY OR BUSINESS 15. PLACE OF BIRTH White Plains, New York (CITY, STATE I COUNTRY IF NOT USA) 16. FATHER A. NAME Edward Anthony Orlando . B. COUNTRY OF BIRTHU S A 17. MOTHER A. MAIDEN NAME Janet Lucille Mangione B. COUNTRY OF BIRTH USA 18. NUMBER OF THIS MARRIAGE 1 19. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIOORCE CIVIL AN~ULMENT D11TH DEaTH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE C. DATE LAST MARRIAGE ENDED? (2) 0 DEAJH (3) 0 ANNULMENT (2) 0 DEATH / / . - YEAR MONTH DAY YEAR . _D_.AF.lE-Awt..F.OIilMEJ;\..Sj;!QUSliiIS)ALIIlE? 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, STATE/COUNTRY, IF NOT USA) SELF SPOUSE 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 / / o 0 1ST o 0 2ND o 0 3RD o 0 4TH and belief that the information I provided is true an o 0 o 0 o 0 o 0 pediment exists 1ST 2ND 3RD 4TH I duly swear/affirm, depose and say, that to the best of m~wle as to my right to enter into the mamage state~ ~ , 21. SIGNATURE OF GROOM. /' USE CURRE 23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE 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 ~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 onl for the urpose of a second or subsequent ceremony. ~ 24. TOWN OR C"J8EF.lKC.Mast 25. A. SOLEMNIZATION PERIOD BEGINS { } NAME (PRINT) SEAL SIGNATURE~' DATE 07/10/2007 TIME MONTH YEAR '-v-I MAI~1j3MRmte u h Rd,. appinger Falls, NY 12590 02:22:~ 07 11 2007 STREET . CITYITOWN STATE ZIP I CERTIFY THAT I SOLEMNIZED 26 SOLEMNiZATION OCCURRED 27~TYPE F CEREMONY THE MARRIAGE OF THE PER. . SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 ELlGIOUS 1 0 CIVIL DATE AND AT THE TIME AND PLACE INDICATED. 9 0 OTHER, SPECIFY 22. SIGNATURE OF BRIDE': DATE by New York Domestic 25. B. SOLEMNIZATION PERIOD ENDS AT MIDNIGHT ON: MONTH DAY YEAR 09 08 2007 28. PLACE WHERE MARRIAGE ~. CURRED } . NEW YO t.7Jc., I/J ~JJ A. STATE RK B. OUNTY C. TITLE Je c.... fk ) t:!..J~ DATE ? I'll lY/ ~' o CITY OF L SPECIFY ~ B f:.,/'<;