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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~ 1368 .
~5~i~~R 62
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Ga~ Krision Wetter
MID LE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kristen Ann Fontanes
MIDDLE CURRENT. SURNAME
-1
1 . A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
0..
N
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 053-70-2646
D. SOCiAl SECURITY NUMBER
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY rY TOWN 0 VILLAGE
~~CIFY WappinQer
D. STREET ADDRESS 23E Alpine Drive
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 083-74-9743
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY Cl"" TOWN 0 VILLAGE
AND W .
SPECIFY ap~ln-ger
D. STREET ADDRESS 23E Alpine Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
03 /24 /1974
MONTH DAY YEAR
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
09 / 13 / 197
MONTH DAY YEAR
13. A. AGE 33
3. A. AGE 28
3B. DATE OF BIRTH
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION I. 1. Specialist
B. TYPE OF INDUSTRY OR BUSINESS I. B. M.
5. PLACE OF BIRTH Suffern I New York
(CITY, STATE / COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Special Education Teacher
B. TYPE OF INDUSTRY OR BUSINESS Chappaqua CS District
15. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE / COUNTRY IF NOT USA) ,
6. FATHER
16. FATHER
A. NAME Ivan Fontanes
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Linda Mildred Fosnar
B. COUNTRY OF BIRTH USA
1
18, NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL ANN~LMENT
DE'()H
A. NAME Gary Wetter
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Silvana Theresa Signorini
B. COUNTRY OF BIRTH U S A
1
8. NUMBER OF THIS MAR81AGE
9, PREVIOUS MARRIAGES
A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEAO
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.-- YEAR
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) (CITYICOUNTY. STATEICOUNTRY. 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 ANMJt.1.:,I!D; PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEAR) (CITY/COUNTY, STATElCOUNTRY. IF NOT USA) SELF SPOUSE
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH ' Q []. 4TH
I duly swear/affirm, dep.Dse and say, that to the best of my knowledge and belief that the information I provided is true
as to my right to enter into the mamage state.
21. SIGNATURE OF GROOM
o
o
o
USE CURR
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State of the authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New York Stat THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for the urpose of a-sec;,pnp or subsequent ceremony.
~ 24. TOWN OR CITY pl RK C M t 25: A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) JO . as erson
{SEAL} SIGNATURE~
'-.t-I MAll~e ,
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDIC~
TIME
MONTH
YEAR
MONTH
YEAR
ZIP
02:0t~
06
2007
08
24 2007
26
28. PLACE WHERE MARRIAGE OC
10 CIVil
A. STATE NEW YORK B. C
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
SIGNATURE ~
i~~DD
STREET
SO. WITNESS TO
o CITY OF ~WN ?F9 If'lLAGE OF
SPECIFYP:~J.~'--7
14 La JJ'<..
NAME (PRINT)
SIGNATURE~
DOH-98 (0312006)
SIGNATURE~