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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
D~ Arnold Qmttcm
COUNTY nutchess
CITY/TOWN Wappinger
~~~:~~ 13fiB
~5~~~R ~3
1. A. FULL NAME
CURRENT SURNAME
l1.
f;;j
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) n.. OA27"~
D. SOCIAL SECURIlY NUMBER 4.~~~__::m
2. RESIDENCE A. N ;'lrATE) B. q~e~~
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W .
SPECIfY applnger
D. STREET ADDRESS 3 I Whitegate Drive Zip 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3. A. AGE 32 3B.DATEOFBIRTH in /17 /1Q73
MQiil'm DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Sheet Met~1 VUnrlflEu
B. TYPE OF INDUSTRY OR BUSINESS I ncall Inion 38
5. PLACE OF BIRTH 5t I Rlli!!: ~nllntv Mi~souri
(CflY. STATE f COUNTRY ~USA)
6. FATHER
A. NAME Amold OVerton
B. COUNTRY OF BIRTH I J ~ A
7. MOTHER
A. MAIDEN NAME MAry A .Innes
B. COUNTRY OF BIRTH I J ~ A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 11
DEATH
o
B. HOW 010 LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MON1li 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) (ClTYICOUNTY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
l>"T A II: t-ILI: NUMIfI:H
(THIS SPACE FOR STATE USE ONL Y)
I
11. A.
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
FULL NAME Grace Ann Carratu
ARST MIDDLE
~
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Overton
(OPTIONAL' SEE REVERSE) 099-64-8839
D. SOCIAL SECUR/lY NUMBER
12. RESIDENCE A. N Y B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY I!f TOWN 0 VILLAGE
~~ClfY Wappinger
D. STREET ADDRESS 3 I Whitegate Dnve
ZIP 1 il~YU
.,
o YES 0 NO
,",79
YEAR
E. IS RESIDENCE WITHIN UMITS OF CIlY OR INCORPORATED VILLAGE?
13. A. AGE 26 38. DATE OF BIRTH 06 Jf7
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Financial Analyst
B. TYPE OF INDUSTRY OR BUSINESS IBM Corp.
15. PLACE OF BIRTH. Bronx. New York
(CITY. STATE f COUNTRY IF NOT USA)
16. FATHER
A. NAME Giovanni Carratu
B. COUNTRY OF BIRTH Italy
17. MOTHER
A. MAIDEN NAME Anna Maria Russo
B. COUNTRY OF BIRTH Italy
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVOCE CIVIL AN'OLMENT
Dew
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATIE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
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. STATEICOUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
SAD
4TH
I duly swear/affinn. depose and say,
as to my right to enter into the mam
21. SIGNATURE OF'GROOM~
o 1ST
o 2ND
o 3RD
o 4TH
belief that the infonnation I provided is true a
by New York Domestic
This license authorizes the marriage in New York.. . ate of the bride. and groom named above by any person authorized
Relations Law ~11 to perfonn marriage ceremonies within Nftw York State. THIS UCENSE 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
~
{ SEAL }
'-v-I
NAME (PRINT)
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATE
TIME
MONTH
15 2006
YEAR
MONTH
YEAR
05
17
2006
07
28. PLACE WHERE MARRIAGE OCC~ _
A. STATE NEW YORK B. COU~~
C. LOCATION OF CEREMONY
(CHECK ONE AN~ECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY fA) #rP(J I~~
ZIP
31. WITNESS TO CER.9!'ONY .
NAME (PRINT) ,Ck,.-".,Iat. 1....'.
./0 SIGNATURE~ . ~ e ~~