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048 + !z W CIl W III o -' ::> o :r CIl z o ~ a W a: w ~ if a: < ::l! u. o W !< (.l ii: ~ w (.l W a: w ~ CIl CIl w a: IS < ~ 13 w a- CIl a:' W III ::IE ::> z Q Z < Iii III a: Ii; w -en z -W o -:J + ~~z W ?~g ~",;:5 t- ~~~ 0< ::>(.lW ::l!(!)cS u: !z;r;CIl - ~~~ t: B:OCll W 0....> 0 w~C5 ....[fiLt> ~g;r; STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM Richard Allan Rundle. III MIDDLE CURRENT SURNAME COUNTY Dutchess CITY/TOWN Wappinger ~~~:~: 1368 ' ~~~~~~R 48 1. A. FULL NAME FIRST a- N B, BIRTH NAME, IF DIFFERENT C. SURNAME AFTER MARRIAGE (OPTIONAL - SEE REVERSE) 119 60 7959 D. SOCIAL SECURITY NUMBER -- 2. RESIDENCE A. New York B. Dutchess (STATi') (COUN1Y) C. CHECK ONE ~ CITY 0 TOWN 0 VILLAGE ~~~CIFY PouQhkeepsie D. STREET ADDRESS 154 Academy Street ZIP 12601 E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? r1 YES 0 NO 3. A. AGE 30 3B. DATE OF BiRTH 04 / 09 / 1977 MONTH DAY YEAR 4. EMPLOYMENT A. USUAL OCCUPATION Realtor B. TYPE OF INDUSTRY OR BUSINESS Patrick Fleming Realty 5. PLACEOFBIRTH Peekskill, New York (CITY. STATE I COUNTRY IF NOT USA) 6. FATHER A. NAME Richard Allan Rundle, Jr. B. COUNTRY OF BIRTH USA 7. MOTHER A. MAIDEN NAME Kathy Keller B. COUNTRY OF BIRTH USA 8. 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 DEAJH 1ST 2ND 3RD 4TH' I duly swear/affirm, aep'0S8 a as to niy right to enter into th 21. SIGNATURE OF GROOM~ I STATE FILE NUMBER (THIS SPACE FOR STATE USE ONL Y) I L 0 SUPPLEMENTAL FILE FROM THE BRIDE Heather Gullotti MIDDLE CURRENT SURNAME ~ 11. A, FULL NAME FIRST B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT C. SURNAME AFTER MARRIAGE Rundle (OPTIONAL - SEE REVERSE) 081-62-7659 D. SOCIAL SECURITY NUMBER 12. RESIDENCEA. New York B. Dutchess (STA!~ (COUN1Y) C. CHECK ONE I!J CITY 0 TOWN 0 VILLAGE ~~~CIFY Poughkeepsie D. STREET ADDRESS 154 Academy Street ZIP 12601 E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO 01 /20 /1976 DAY YEAR 13. A. AGE 31 3B. DATE OF BIRTH MONTH 14. EMPLOYMENT A. USUAL OCCUPATION Speech patholo~ist B. TYPE OF INDUSTRY OR BUSINESS Volz & ssociates 15. PLACE OF BIRTH Poughkeepsie, New York (CITY. STATE I COUNTRY IF NOT USA) 16. FATHER A. NAME Frank Nicholas Gullotti 'B. COUNTRY OF BIRTH USA 17. MOTHER A. MAIDEN NAME Angela Celeste Calabrese B. COUNTRY OF BIRTH USA 1 18. NUMBER OF THIS MARRIAGE 19. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DI~RCE CIVIL ANOULMENT D'tJTH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE C. DATE LAST MARRIAGE ENDED? MONTH DAY D. ARE ANY FORMER SPOUSE(S) AUVE? 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/COUN1Y. STATEICOUNTRY. IF NOT USA) SELF SPOUSE (3) 0 ANNULMENT (2) 0 DEATH / / . -.- YEAR o 0 1ST o 0 2ND o 0 3RD o 0 4TH best of my knowledge and belief that the information I provided is true an o 0 o 0 o 0 o 0 that I declare ~~nt exists USE CURRENT NAME 06/12/2007 DATE by New York Domestic TIME USE RRE 23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME SIGNATURE OF TOWN OR CITY CLERK ~ This license authorizes the marriage in New York State of he bride and groom named above by any person Relations Law ~11 to perform marriage ceremonies within New Yo o If checked, this license is to be use ~ 24. TOWN OR CITYJ CI,ERK C M t NAME (PRINT) onn . as erson {SEAL} SIGNATURE ~ e. '-v-' MAI't(j' ~atffeb h Rd, STREET I CERTIFY THAT I SOLEMNIZED THE MARRIAGE OF THE PER- SONS NAMED ABOVE ON THE DATE AND AT THE TIME AND PLACE INDICATED. MONTH DATE 06/12/200 ppinger'Falls, NY 12590 11 2007 ClTYrrOWN 26. SOLEMNIZATION OCCURRED IME MO. Y YEAR YEAR MONTH YEAR ZIP AM 01 :09pM 06 13 2007 08 STATE 27. TYJE OF CEREMONY o [!( RELIGIOUS 9 0 OTHER. SPECIFY 10 CIVIL 28. PLACE WHERE MARRIAGE OCCURRED A. STATE NEW YORK B. COUNTY 'pw+J,€55 TITLE (..;/1,"'/.'(.. Pr\~s t DATE ~ 2..9,2.007 IJy '<.5"2.. Y STATE ZIP 31. WITNESS T REMONY .:; AM 7 2 i 29. OFFICIANT R..o ~c2...t g e~,Q, ~j NAME (PRINT) . ~ SIGNATURE ~ J{~ il .. . MAILING ADDRESS 10 5 Jakksov, ~4-veef. Box'L Pie. ~ kiij STREET 7 CITY/TOWN 30. WITNESS TO CEREMONY 07 NAME (PRINT) SIGNATURE~ DoH-98 (0312006) C. LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) o CITY OF ~OWN OF 0 VILLAGE OF SPECIFY h'S ~ ki ~ NAME (PRINT) SIGNATURE~