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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
G~peladste MIDDLE
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New YorI<. 8ta bride and groom named above by any person authorized by New York Domestic
Relations Law !j11 to perform marriage ceremonies within ew York State. THIS LICENSE 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
COUNTY Dutchess
CITYffOWN 'Napping<<
DISTRICT 1368
NUMBER
~G~I~J~R 22
1. A. FULL NAME
CURRBIT SURNAME
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B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAl - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 098-6&-9112
2. RESIDENCE A. N.T~ ot:k B. l(jg,l
C. ~~5CK ONE ~ CITY 0 TOWN 0 VILLAGE
SPECIFY Br~
D. STREET ADDRESS 37A ~_ ~ stre8t ZIP 11203
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED Vll.LAGE? ~ YES 0 NO
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3. A. AGE 37
4. EMPLOYMENT
A. USUAL OCCUPATION RP-!ltP-Arm A~
B. TYPE OF INDUSTRY OR BUSINESS l(eItd And Company
5. PLACEOFBIRTH~l'T~
6. FATHER
3B. DATE OF BIRTH
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A. NAME Guillaume CeleriFP-
B. COUNTRY OF BIRTH Haiti
7. MOTHER
A. MAIDEN NAME MaFIa. 0810,(
B. COUNTRY OF BIRTH Haiti
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
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B. HOW 010 LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATEICOUNTRY,IF NOT USA) SELF SPOUSE
o 0
o 0
o 0
21. SIGNATURE OF GROOM ~
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{ SEAL}
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NAME (PRINT)
\-
51 A I t: t'ILE: nUMD~n
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. FULL NAME Rita A. little
FIRST
CURRENT SURNAME
MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Celariste
(OPTIONAL. SEE REVERSE)1~ ~A .83'76
D. SOCIAL SECURITY NUMBER -~~,
12. RESIDENCEA.NewVork: B. ~
(STAi"E) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VilLAGE
AND WS......
SPECIFY ......naer lLJt
D. STREET ADDRESS 7 ~ Canter'b.IrfY Lane
E. IS RESIDENCE WITHIN UMrrs OF CITY OR INCORPORATED VILLAGE?
13.A. AGE3R 13.B.DATEOFBIRTH 03 21
MONTH DAY
ZIP 12590
DYES tJ NO
1.967
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION AdvIsQ[
B. TYPE OF INDUSTRY OR BUSINESS SUny New peltz
15. PLACE OF BIRTH BrNWlvn, New York:
(C~COUNTRY IF NOT USA)
16. FATHER
A. NAME Robert UtIle
8. COUNTRY OF BIRTHU SA
17. MOTHER
A. MAIDEN NAME In~ RnnnA
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
1 0
8. HOW 010 LAST MARRIAGE END? (3) r1' DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 01 / 17 /2003
MONTH.J DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ITYES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 01/17J2003 KI~r New York 0 ~
~D 0 0
3RD 0 0
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gal impediment exists
DEATH
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SIGNATURE OF BRIDE ~
TIME
. MONTH
YEAR
MONTH
YEAR
DATE ll'V2312DD6
1 0:43AM
PM
ZIP
24 2006 05 22 2006
28. PLACE WHERE MARRIAGE OCCURRED fsSSA l
A. STATE NEW YORK B. COUNTY JJi ~ r
03
S
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
STATE
2nPE. OF CEREMON}
o ELlGIOUS'
9 OTHER, SPECIFY
10 CIVIL'
29. OFFICIANT
NAME (PRINT)
lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
~CITY OF 0 TOWN OF 0 VilLAGE OF
SPECIFY F J JY(f1 L rfJR.. I::::
NAME (PRINT)
SIGNATURE ~
. e.,..
_.,~____________________~.r~':~",-':"~~~:'"
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