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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FIRST Step~~O~EDavid TUluQR~ru~NAME
I
I
STATE FILE NUMBER
(TH/S SPACE FOR STA TE USE ONL Y)
COUNTY Dutchess
CITYITOWN WappinQer
~~~~~c: 1368 .
~5~~~~R 157
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Michelle Anna Valenti
MIDDLE CURRENT SURNAME
-.J
11. A. FULL NAME
FIRST
..
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Turner
(OPTIONAL - SEE REVERSE) 126-70-2137
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r:I TOWN 0 VilLAGE
~~~CIFY East Fishkill
D. STREET ADDRESS 58 Mountain Top Road ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
13. A. AGE 20 3B. DATE OF BIRTH 05 /11
MONTH DAY
12582
YES ~ NO
,,1986
YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 054 72 1609
D. SOCIAL SECURITY NUMBER --
2. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r!I' TOWN 0 VILLAGE
~~CIFY WappinQer
D. STREET ADDRESS 14 F Chelsea Ridge Drive ZIP
12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES t5 NO
10 / 30 / 1983
MONTH DAY YEAR
3. A. AGE 22
3B. DATE OF BiRTH
4. EMPLOYMENT
A. USUAL OCCUPATION HV AC Mechanic
B. TYPE OF INDUSTRY OR BUSINESS Appolo Heating, Inc.
5. PLACE OF BIRTH PouQhkeepsie, New York
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Steohen David Turner
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Catherine Marie Pezzulo
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARF,UAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION Cashier
B. TYPE OF INDUSTRY OR BUSINESS MDJ Wines & Liquors
15. PLACE OF BIRTH Danbury, Connecticut
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Peter Joseph Valenti, Jr.
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Joann Marie Acheson
B. COUNTRY OF BIRTH U S A
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL AN~LMENT
DEATH
o
DE~H
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. '.~ YEAR
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
1ST 0 D 1ST
2ND 0 D 2ND
3RD 0 D 3RD
~ 0 D ~
I duly swear/affinn, dep.ose and sa I that to the best of my knowledge and belief that the infonnation I provided is true a
as to my right to enter into the m age state.
21. SIGNATURE OF GROOM. . 22. SIGNATURE flF BRIDE.
USE CU RENT NAME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE M
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
W Relations Law ~11 to perfonn marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
en 0 If checked, this license-is to be used only for the purpose of a second or subsequent ceremon .
Z ~ 24. TOWN OR CITYJCL,ERK C M t 25. A. SOLEMNIZATION PERIOD BEGINS
W NAME (PRINT) onn . as e on
~ {SEAL} SIGNATURE ~
MAI~ 'rOO
'-v-I
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
by New York Domestic
YEAR
TIME
MONTH
YEAR
MONTH
06:0~~
09
28
2006
11
26 2006
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COU~\'\~(~
C. LOCATION OF CEREMONY
(CHECK ONE A!;lP SPECIFY)
o CITY OF 16 TOWN OF 0 VILLAGE OF
-' - .\\ ,\\~
SPECI~' ~ \~~\\._\\.,~
ZIP
31. WITNESS ~<A CERcjONY \ I '
NAME (PRINT) 122 ,ff\ ;,D.~,
It "11"~
SIGNATURE~ . Ii