065
~ IA II: UI- NI:W YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
steven H. Tang
FIRST MIDDLE
COUNTY Dutchess
CITYrTOWN Wappinger
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I, being duly sworn, depDse and say, that to the be f my knowledge and belief that the infDrmatiDn I provided is true :rl2'mpe . xists
as to my right to enter intD the marriage st I
21. SIGNATURE OF GROOM. I"
23. SUBSCRIBED AND SWORN TO BEF NT N E 01/1412005
SIGNATURE OF TOWN OR CITY CL DATE
This license authorizes the marriage in New York State f the bride and groom named above by any person authorized by New York Domestic
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.
~ 24. TOWN OR CITYJ LERIS... M st 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) t;. a ers
{TIME MONTH YEAR MONTH
SEAL SIGNATURE.
'-y-I M'10'tJO 12:15 ~~ 01 15 2005 09 12 2005
STREET ZIP
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
1. A FULL NAME
CURRENT SURNAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)055-68-1540
O. SOCIAL SECURITY NUMBER
2. RESIDENCE A. N Y B. Queens
(ST~) (COUNTY)
C. CHECK ONE 1] CITY 0 TOWN 0 VILLAGE
~~~CIFY Queens
O. STREET ADDRESS 48-42 45 Street ZIP 11377
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
3. A. AGE 29 3B. DATE OF BIRTH 08 /20 /1975
MDNTH OA Y YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Consultant
B. TYPE OF INDUSTRY OR BUSINESS C G I - A M S
5. PLACE OF BIRTH Manhattan, New York
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Wai Ving Tang
B. COUNTRY OF BIRTH China
7. MOTHER
A MAIDEN NAME Paula Tsui- Wan Lee
B. COUNTRY OF BIRTH China
8. NUMBER OF THIS MARRIAGE 1
9. 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
10. 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
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(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
~
11. A.
FROM THE BRIDE
FULL NAME Danielle Stephanie Perrotto
FIRST MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Perrotto
D. S6~~~I~~~R~T~E~U~~~~RSE) 120-60-5691
12 RESIDENCE AN V B Dutchess
(STATE) ~ (COUNTY)
C. CHECK otji .hi. CITY 0 TOWN 0 VILLAGE
~~~CIFY ...ougnKeepsle
D. STREET ADDRESS 33 Lakevaew Road
ZIP 1 Z6UJ
.;
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 Y1Ei~1 NO
13. A. AGE 27 13.B. DATE OF BIRTH 12 .os ~
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Psychologist
B. TYPE OF INDUSTRY OR BUSINESS t::lmstord ~ch. DISI.
15. PLACE OF BIRTHMt. Vemon, New York
(CITY. ST A TElCOUNTRY IF NOT USA)
16. FATHER
A. NAME steven John Perrotto
B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Kathleen Marie Ruth
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DE6TH
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
YEAR
STATE
27. TYP7DF CEREMONY
o ~ELlGIOUS
9 0 OTHER, SPECIFY
29 OFFICIANT
NAME (PRINT)
NAME (PRINT)
SIGNATURE.
DOH.98 (11198)
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~TtIH:S>
TITLE
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~AGE OF
SPECIFY WMf'f~ @T,J2S ~s
~ ,e, /k15r
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ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) {Vtid1 '11t:..- rr/.M fjl,}-"i. .!.::;:::; fa.;;
SIGNATURE. YiAu~ ~ '