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~ I AI t:. UF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Stephen Sean Hanson
B. HOW DID lAST MARRIAGE END? (3) 0 DlVO'B2 (3) ~SNULMENT ~ 0 DEATH
C. DATE LAST MARRIAGE ENDED? / / 19 8
MONY 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
.lNQ~~ \l&"-XEARl.. (CIIY. STATi'POUNTflY. IF NOT USA) SELF SPOU:;E
15T uou"rnnfU \:;osnen, New york 0 tJ 15T
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I. being duly sworn. depose and say. that to the best 0 my knowledge and belief that the information I provided is tru a
as to my right to enter into the m rriage st e.
1. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)082-68-5483
0_ SOCIAL SEc~\~rfUMBER
2 RESIDENCE A. B. Dutchess
(STATE) ~ (COUNTY)
C. CHECK ONp iha9ITY D. TOWN 0 VILLAGE
~~~CIFY oug I\eepsle
D. STREET ADDRESS 1 ~ Pine t:.cno unve
ZIP 12601
YES tJ NO
/1969
YEAR
E. IS RE~gCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0
3. A. AGE 3B. DATE OF BIRTH 01 /06
MONTH DAY
4. EMPLOYMENT .
A-:- U50ALOCGUPATION1 -TProfesslonal
B. TYPE OF INDJI~ BUS~E~I ti M corp.
5. PLACE OF BIRTH urg, ew York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Russell B. Hanson
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Edith Hewitt
B. COUNTRY OF BIRTH U S2 A
B. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVrCE CIVIL A"ftULMENT
DliTH
.-
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
11. A.
FROM THE BRIDE
FUll NAME Karin Anneliese Cantone
FIRST MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Hanson
(OPTIONAL - SEE REVERSE) 120-74-5615
D. SOCIAL SECURITY NUMBER
12. RESIDENCE AN Y B Dutchess
(STATE) J (COUNlY)
C. CHECK ONE 0 CITY LI TOWN 0 VILLAGE
ANDP hk .
SPECIFY oug eepsle
o STREET ADDRESS 19 Pine Echo Drive
ZIP 12601
DYES '6 NO
1Q14
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE?
13. A. AGE 31 13.B. DATE OF BIRTH 04 22
MONTH DAY
14. EMPLOYMENT
---,;: USUAL OCCUPATIONData-Entry----------- - - - .
B. TYPE OF INDUSTRY OR BUSINESS Royal Cartinq
15. PLACE OF BIRTH Queens , New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Salvatore Cantone
B. COUNTRY OF BIRTM S A
17. MOTHER
A. MAIDEN NAME Marpot Stiegeler
B. COUNTRY OF BIRTtWest Germanv
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID 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
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
o 0
o 0
o 0
o 0
legal impediment exists
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21. SIGNATURE OF GROOM ~
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CllY CLERK ~
This license authorizes the marriage in New York State the bride and groom named above by any person autho ized
Relations Law ~11 to perform marriage ceremonies within New 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.
r-I'-. 24. TOWN OR CJOti t. Mast 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) erson
{SEAL ''''''''"'' ~ ~ ",,,08lD3l2l105 ""' ""
'-v-I Ml9 appinger Falls, NY 12590
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
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NAME (PRINT)
SIGNATURE ~
DOH-9B (11/9B)
A
DATE 0810312005
by New York Domestic
MONTH
YEAR
10
02 2005
ZIP
1~Vll
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTyD.&lc..n(~
C. LOCATION OF CEREMONY
(CHECK ONE AN}' SPECIFY)
o CITY OF rr;/ TOWN OF 0 VILLAGE OF
SPECIFY
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE ~