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053 o m ID ~ N Iii 'r" >= z I ~ ll$ I~ a: f 1:1 i -- W a: f> ill III ~ W z a: c ~ ~ ~ Iii &i ~ l1. CD w -0 Z -w (,) -:::::i ~~~ w ~ 1f ~ !::: ~ffiz ..... ~~~ (,) ~CJO u: !z~<Il - ~gj~ ~ itC;", W Of-~ (,) UiMlc 15~"' z::;~ 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 ~~