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STATE OF NEW YORK I STATE FILE NUMBER I
(THIS SPACE FOR STA TE USE ONL Y)
COUNTY Dutchess DEPARTMENT OF HEALTH
CITYrrOWN Wappinger AFFIDAVIT, LICENSE and
DISTRICT 1368
NUMBER
REGISTER 26 CERTIFICATE OF
NUMBER
MARRIAGE Lo SUPPLEMENTAL FILE ~
FROM THE GROOM FROM THE BRIDE
1. A. FULL NAME Alberto Diego Lo~ez 11. A. FULL NAME Kimberlv Lauren Morris
FIRST MIDDLE CUR ENT SURNAME FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 048 74 0822
D. SOCIAL SECURITY NUMBER --
2 RESIDENCE A Connecticut B. Fairfield
(STATE) (COUNTY)
C. CHECK ONE oil CITY 0 TOWN 0 VILLAGE
AND D b
SPECIFY an u ry
D. STREET ADDRESS 57 South Street, Unit 2 ZIP 06810
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 'lvES 0 NO
3. A. AGE ?5 3B. DATE OF BIRTH 11/ 18 / 198
MONTH DAY YEAR
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Lopez
(OPTIONAL. SEE REVERSE) 088-66-5483
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN 0 "'VILLAGE .
~~~CIFY Wa in ers Falls
D. STREET ADDRESS 12 North Mesier Avenue
ZIP 125 0
E. IS RESIDENCE WITHIN LIMITS Of'CITY OR INCORPORATED VILLAGE? O"'VES 0 ~,NO
03 / 30 /1982
MONTH DAY YEAR
25
13. A. AGE
3B. DATE OF BIRTH
4. EMPLOYMENT
14. EMPLOYMENT
A. USUAL OCCUPATION Investor Relations
B. TYPE OF INDUSTRY OR BUSINESS Hedge Fund Company
15. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE / COUNTRY IF NOT USA)
A. USUAL OCCUPATION Collections
B. TYPE OF INDUSTRY OR BUSINESS Commercial Finance
5. PLACE OF BIRTH Bridoeport, Connecticut
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
6. FATHER
A. NAME Alberto Eduardo Lopez
B. COUNTRY OF BIRTH Arqentina
7. MOTHER
A. MAIDEN NAME Rosana D'auria
B. COUNTRY OF BIRTH Arqentina
8. NUMBER OF THIS MARF,UAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER.OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
A. NAME Thomas Edward Morris, Jr.
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Mary Catherine Damm
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
, - YEAR
B. HOW DID LAST MARRIAGE END?
C. DATE LAST MARRIAGE ENDED?
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, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
MONTH OA Y
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
1ST
2ND
3RD
4TH
I dulyswear/affirm,aepose a
as to my right to enter into \
21. SIGNATURE OF GROOM~ '
o
o
o
1ST
2ND
3RD
o
o
o
23. SUBSCRIBED AND SWORN TOfAFFIRMED.BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New' k State f 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
} NAME (PRINT) John C. Masterson
{ ~ ~ ~
SEAL SIGNATURE ~ DATE 04/18/20
'-- .-.J MAILlIiG~~flIE:>& AM 9 2
-yo- LU IVIlaa , Wappinger Falls, NY 12590 07:0~ 04 1 00
STREET ClTYfTOWN STATE ZIP
~~~R~~Ri~~~ IO~O~~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE CEREMONY
SONS NAMED ABOVE ON THE TIME M. DAY YEAR 0
DATE AND AT THE TIME AND
PLACE INDICATED.
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON;
MONTH
DAY
YEAR
06
17 2007
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY.])tfrt.l..tiSS
29. OFFICIANT
NAME (PRINT)
If, ~ P~/;"/
'1-/ ,;)..'! (07
f
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF, OJ TOWN OF ~LAGE OF
SPECIFY W 1fI:(J,',.;jGCRS {i:J.u.s.
TITLE
DATE
NAME (PRINT)
SIGNATURE~