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23. SUBSCRIBED AND SWORN T 1AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CLERK ~
This license authorizes the marriage in New York State of the ride and groom named above by any person authorized
W Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
UJ 0 If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
Z r-^-. 24. TOWN OR CITYJCl,ERnK C M t r n 25. A. SOLEMNIZATION PERIOD BEGINS
W NAME (PRINT) on . as e so
~ {SEAL} SIGNATURE ~ .
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
James Michael Dumser. JR.
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~c: 1368 .
~~~I~~~R 88
1. A. FULL NAME
FIRST
Q.
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 120 64 5489
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Westchester
(STATIiI (COUNlY)
C. CHECK ONE I!I CITY 0 TOWN 0 VILLAGE
~~~CIFY Mt. Vernon
D. STREET ADDRESS 35 Alta Drive ZIP 10552
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? dYES 0 NO
3. A. AGE 26 3B. DATE OF BiRTH 10 / 02 / 1979
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Police Officer
B. TYPE OF INDUSTRY OR BUSINESS City Of Mt. Vernon
5. PLACE OF BIRTH Bronx, New York
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME James Michael Dumser
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Deborah Marie Morley
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. ~~~~~~~RM6'FR~~&Tgus 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 DEATH
YEAR
MONTH DAY
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
1ST
2ND
3RD
o
o
o
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
DATE 07/06/200
appinger Falls, NY 12590
04 2006
CITYrrOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
I"
"I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Jamie Lynn Woods-Fortunato
FIRST MIDDLE CURRENT SURNAME
-.J
11. A. FULL NAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE D u mse r
(OPTIONAL - SEE REVERSE) 076-70-8216
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B Westchester
(STAISl (COUNTY)
C. CHECK ONE ~ CITY 0 TOWN 0 VILLAGE
~~~CIFY Yonkers
D. STREET ADDRESS 85 Bronx River Rd. Apt. 4 I ZIP 10704
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
13. A. AGE 23 3B. DATE OF BIRTH 08 /28 /f982
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Police Officer
B. TYPE OF INDUSTRY OR BUSINESS City Of Mt. Vernon
15. PLACE OF BIRTH Bronx, New York
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Robert James Fortunato
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Donna Lynn Woods
B. COUNTRY OF BIRTH U S A
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV8RCE CIVIL ANrcyLMENT
DE'(JH
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, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
o 0
o 0
o 0
o 0
pediment exists
;;:tJ
by New York Domestic
ZIP
..../ .
YEAR
MONTH
YEAR
2006
09
STATE
27. TYPE OF CEREMONY
o ~ RELIGIOUS
DC. 9 0 OTHER, SPECIFY
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY 'Br'''')C
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
Ii CITY OF 0 TOWN OF
SPECIFY Nn. y...~
TITLE j.ft~ Co.u..I:c
+/2I/DL
10 Lj LL
~
II
S~GD
PM
29. OFFICIANT~' 'J'~
NAME (PRINT) I\c V. ~t IJ . '. ,...
SIGNATURE~ ~v. ~ . ......./
MAILING ADD~S ~
14'O} 1>>.,.....) liv..... Vt By.""
STREET CITYrrOWN
30. WITNESS TO CEREMONY k
NAME (PRINT) P '" ~'I C _
SIGNATURE~
bOH-98 (0312006)
DATE
Nc.., Yc, k.
STATE
.,.,i., A..
o VILLAGE OF
ZIP
" WITH"" m "'''M~ . /'
NAME(PRINT) ~ ~~ ~
SIGNATURE~ - -- "A 'a4ft7