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COUNTY OIVhes.S
CITYITOWN Wappinger
~~~~IfRT 1368
~5~~J~R 26
~ I A It: Ur- 1~t:VV Tunl'
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Sohail YaO'leef'l $1 ,Ie-m~f\
MIDDLE CURRENT SURNAME
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Umma Amina
MIDDLE CURRENT SURNAME
.-J
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
B BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE AminA
(OPTIONAL - SEE REVERSE) ~
D. SOCIAL SECURITY NUMBER 318-78-855J
12. RESIDENCE A. C'..alifomiA B Alameda
(STATEl (COUNTY)
C. CHECK ONE [Y' CITY 0 TOWN 0 VILLAGE
~~~CIFY Oakland
D STREET ADDRESS 275 41st street. Apt. 215 ZIP 94611
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? f'1! YES 0 NO
13. A. AGE 28 13.8 DATE OF BIRTH flI\ /17 -1Q7€
M/Im"H DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 052.58-2870
2. RESIDENCEA~mia B ~~
C. CHECK ONE 'iI CITY 0 TOWN 0 VILLAGE
AND
SPECIFY OAIdAnd
D. STREET ADDRESS '}75 41~ str~ Apt 215 ZIP 94811
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? r!I YES 0 NO
MO~ / ~^' / ~W5
3. A. AGE 29
4. EMPLOYMENT
A. USUAL OCCUPATION SnfI\NAr~ I=nginAer
B. TYPE OF INDUSTRY OR BUSINESS ~-Arnpl~fI!d
5. PLACE OF BIRTH ~mJ!~~ .NnXnrk'
6. FATHER
38 DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Nurse
8 TYPE OF INDUSTRY OR BUSINESS Kaiser Oakland Ho$p.
15. PLACE OF BIRTH Karachi Pakistan
(CITY, STATEitOUNTRY IF NOT USA)
16. FATHER
A. NAME Khwaja WAhAb
B. COUNTRY OF BIRTH India
17. MOTHER
A. MAIElEN NAME Nasa A1i
B. COUNTRY OF BIRTH Paldstan
1 B. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
A NAME Ilsman Sulemen
B COUNTRY OF BIRTH India
7. MOTHER
A MAIDEN NAME Salma Satter
B. COUNTRY OF BIRTH Pakistan
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
o
B. HOW DID LAST MARRIAGE END? (3) Q'i\jIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 10/ 14 / 2003
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 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
10/14J200~ FairfaY Co . Virg;nia
o
o
YEAR
MONTH DAY
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
nI
o
o 0
o 0
o 0
re that no legal impediment exists
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
f my knowledge and belief that the information I provided is true an
f
{
21. SIGNATURE OF GROOM ~ I
04f2112OO5
OATE
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
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 CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
by New York Domestic
~
{ SEAL }
'-y-I
TIME
MONTH
YEAR
NAME (PRINT)
/C/~
SIGNATURE ~ k..:--r~
MAILING ADDRESS
10:2:rM
PM
04
ZIP
STATE
27. TYPE OF CEREMONY
o ~ELlGIOUS
9 0 OTHER, SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNTY ~
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
AM
7 !19PM
10 CIVIL
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF Jii!' TOWN OF 0 VILLAGE OF
SPECIFY W/tP/J1 J.J4 ~f(t
29. OFFICIANT $II..tlo IJ I' A 7" K
NAME (PRINT) ~ n 10 lr .
SIGNATURE ~ ~l>>.2- f(.
M1~G ~r;~tvER /t.}J tltG/A/
STREET CITYITOWN
30. WITNESS TO CEREMONY
NAME (P1t~. jUl
SIGNATURE~
DOH-98 (11/98)
(J H.p TITLE Ah K A H K HAW#. /Yl If.
i{ / ).,3/ /) S-
f I
, /IJ /2- $-!>C
STATE ZIP
31. WITNESS TO CEREMONY
""",.,,,, ~ US/YIIr,v ~ StlLE/YIA tJ
SIGNATURE ~ J