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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Brian Christopher Matte
MIDDLE CURRENT SURNAME
1ST D D 1ST
2ND D D 2ND
3RD D D 3RD
4TH D D 4TH
I duly swear/affirm, clep.ose and say that to the be~O y kno ledge and belief that the information I provided is true and that I
as to my right to enter into the ma age Iltate.
21. SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~
USE CUR ENT NAME .
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 by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
D If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITYJCI,.ERKC M t 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) onn , as erson
{SEAL SIGNATURE ~. DATE 10/04/200 TIME MONTH DAY YEAR MONTH DAY YEAR
'--.-J MAI~~a appinger Falls, NY 12590 AM 10 05 2006 12 03 2006
-v- 05: 14pM
STREET ClTYrrOWN STATE ZIP
~~~R~:RT~~J ~~O~~N~i~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIM MO. DAY YEAR 0 k RELIGIOUS
DATE AND AT THE TIME AND t::', ,..,. AM
PLACE INDICATED. .,). vu M \ I I 06 9 D OTHER, SPECIFY
29. OFFICIANT srevs:rv P e", t::f< S (J ,.....
NAME (PRINT)
....&~ r .....:r~S'C/)'...
/t-V/:, e- ;rSlip
CITYrrOWN
COUNTY Dutchess
CITYfTOWN Wappinger
~~J:~~ 1368 .
~5~:J~R 163
1. A. FULL NAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 433 65 7219
D. SOCIAL SECURITY NUMBER --
2. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE D CITY ~ TOWN D VILLAGE
~~CIFY Wappinger
D. STREET ADDRESS 11 H Alpine Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? D YES ~ NO
3. A. AGE 32 3B. DATE OF BIRTH 03 / 20 / 1974
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Registered Nurse
B. TYPE OF INDUSTRY OR BUSINESS Healthcare
5. PLACE OF BIRTH Portsmouth, Virginia
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Joseph Walter Lee Matte. Jr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Marie Ann Gallagher
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MAR81AGE 1
9. ~~~~~~~RM6'f~IfE~Tgus MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) D ANNULMENT
/ /
(2) D 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) (CITYICOUNTY, STATElCOUNTRY. IF NOT USA) SELF SPOUSE
I
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
EileEtQD~arv Flan~~~E~T SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Matte
(OPTIONAL - SEE REVERSE) 078-68-5837
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE D CITY r!'1 TOWN D VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 11 H Alpine Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CllY OR INCORPORATED VILLAGE? D YES ~ NO
02 /21 /1'971
DAY YEAR
13. A. AGE 35
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Executive Assistant
B. TYPE OF INDUSTRY OR BUSINESS LaGuardia Comm Coli
15. PLACE OF BIRTH Rockville Centre, New York
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Richard Michael Flanagan
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Carol Ann Rochford
B. COUNTRY OF BIRTH USA
lB. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIORCE CIVIL AN5ULMENT
DE6TH
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) D ANNULMENT (2) D DEATH
/ /
.'- YEAR
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D NO
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
D 0
D D
D D
D 0
eclare that no legal impediment exists
NAME 1 0/04/2006
DATE
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
2B. PLACE WHERE MARRIAGE OCCURRED
1 D CIVIL
A. STATE NEW YORK B. COUNTY SV FFO<..lc
TITLE Rq"'AW C/J.l'k<<.ic. ft<i
1'1- 20~~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF B TOWN OF D VILLAGE OF
SPECIFY Ii:. .I S Li P
SIGNATURE ~
MAILING ADDRESS
J 0 Itjq..MiSo)V
STREET
30. WITNESS TO CEREMONY
DATE fulJv ~
~T~
NAME (PRINT)
SIGNATURE~
bOH-9S (0312006)
NAME (PRINT)
SIGNATURE~