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23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New Y State of e 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 D If checked, this license is to be used only for the urpose of a second or subsequent ceremony.
Z ~ 24. TOWN OR CI1J8 ERKC. MastersOn 25. A. SOLEMNIZATION PERIOD BEGINS
W { } NAME (PRINT)
~ SEAL SIGNATURE ~ DATE 08/10/2006 YEAR
MAI~ MMEfl appinger Falls, NY 12590
'-.,-.I STREff CITYrrOWN STATE
~~~R~~R~~~ IO~O~~N~:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 D RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 D OTHER, SPECIFY
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
William Carl Reuter
MIDDLE CURRENT SURNAME
9. ~~~~~~R~~R~~~~8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DE-\rH
1 0 U
B. HOW DID lAST MARRIAGE END? (3) D'DIVORCE (3) D ANNULMENT ~03DEATH
C. DATE LAST MARRIAGE ENDED? 07 / 30 / 2
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
(~H'8",v".XEA'3l .. 1\t1l)'1C04J':{T,YI,llTATElCQI/NTRY.1f ]lOT ~SA) SELF SPOUSE
1ST ur/3 '/~UO~ vvnlte I-"lamS, New YOrK r!5 1ST
D 2ND
o 3RD
o 4TH
nd belief that the lnfonnation I provided is true and that I
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COUNTY Dutchess
CITYITOWN Wappinger
~~~:~: 1368 .
~~~~~~R 123
1. A. FULL NAME
FIRST
Il.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 080 52-8268
D. SOCIAL SECURITY NUMBER -
2. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE D CITY!!1 TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D. STREET ADDRESS 6 Alex Way ZIP 12603
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
11 / 09 / 1957
MONTH DAY YEAR
3. A. AGE 48
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Retired
B. TYPE OF INDUSTRY OR BUSINESS
5. PLACE OF BIRTH Lawrence, Massachusetts
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Carl Raymond Reuter, Jr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Dorothy Mathilda Jacobucci
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
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21. SIGNATURE OF GROOM
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STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
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SUPPLEMENTAL FILE
FROM THE BRIDE
Sylvia Um Sap lad
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Reuter
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York
(STATE)
C. CHECK ONE 0 CITY ~ TOWN 0
~~CIFY Poughkeepsie
D. STREET ADDRESS 6 Alex Way ZIP 12603
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES t'i NO
08 /25 )'967
DAY YEAR
8. Dutchess
(COUNTY)
VILLAGE
13. A. AGE 38
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Unemployed
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Cebu City, Philippines
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Unknown
'B. COUNTRY OF BIRTH Un known
17. MOTHER
A. MAIDEN NAME Maura Saplad
B. COUNTRY OF BIRTH Philippines
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DI'iYRCE CIVIL AN5ULMENT
D~TH
B. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
,'- YEAR
C. DATE LAST MARRIAGE ENDED?
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) (CITYICOUNTY. STATElCOUNTRY. IF NOT USA) SELF SPOUSE
22. SIGNATURE OF BRIDE ~
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impediment exists
08/10/2006
by New York Domestic
ZIP
YEAR
10
09 2006
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B.COU~TC~
NAME (PRINT)
SIGNATURE~