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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christopher J. Basso
MIDDLE CURRENT SURNAME
COUNTY ~
CITYITOViN wappinger
~ISTRICT 1388
,'IUMBER
REGISTER 129
NUMBER
1. A. FULL NAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) Q84.6O. 7381
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New Jersey .B. Burlington
(STATE) ~ (COUNTY)
C. CHECK ONE 0 CITY [J""TOWN 0 VILLAGE
~~~CIFY Delran
D. STREET ADDRESS 20 FOXglove onve
08075
YES r:I NO
/197
YEAR
ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
09/21
MONTH DAY
A. AGE 30
3B. DATE OF BIRTH
EMPLOYMENT
A. USUAL OCCUPATION Account
B. TYPE OF INDUSTRY OR BUSINESS Crown cork & seal
PLACE OF BIRTH Greenwich, Connecticut
(CITY, STATE/COUNTRY IF NOT USA)
FATHER
A. NAME Joseph R. Basso
B. COUNTRY OF BIRTH USA
MOTHER
A. MAIDEN NAME Mary Ann D41ardn
B. COUNTRY OF BIRTH USA
NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVOCSE CIVIL ANNOENT
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Christie M. Murphy
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Basso
(OPTIONAL. SEE REVERSE) 052-58-2255
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New Jersey B. Somerset
(STATE) ~ (COUNTY)
C. CHECK ONE 0 CITY O"TOWN 0 VILLAGE
AND Bridgewater
SPECIFY :-3'709"RI
D. STREET ADDRESS dele court ZIP 08807
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES ~ NO
01 /04 /1976
MONTH OA Y YEAR
13. A. AGE 28
13.B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Consuttant
B. TYPE OF INDUSTRY OR BUSINESS Accenture
15. PLACE OF BIRTH Albany, NewVork
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Donald Francis Murphy
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Suzanne Dlene Latrever5e
B. COUNTRY OF BIRTH USA
1 B. 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
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH OA Y 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
e that no legal impediment exists
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1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I, being duly swom, depose and say, that to the best of my knowledge and be lef that the In ormation I prOVided is true
as to my right to enter into the marriage te.
21. SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~
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DATE
authorized by New York Domestic
for the purpose of a second or subsequent ceremony.
25. A. SOLEMNIZATION PERIOD BEGINS
TIME
MONTH
YEAR
ZIP
AM
01 :O&M
10
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
STA
27. TYJE OF CEREMONY
o tV"RELlGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
28. Pl.ACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNT'i)V1l JiE6S
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF liYVlLLAGE OF
SPECIJJd~..p(>p.)tII54 f/Jl.:.1>~
NAME (PRINT)
SIGNATURE Ii>
DOH-98 (11/98)
NAME (PRINT)
SIGNATURE ~