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COUNTY Dutchess
crrYfTOWN Wappinger
~~J~kCRT 1368
~5~I~J~R 89
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Faisal S. Ahmad
CURRENT SURNAME
MIDDLE
CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL V)
I
Obit
7, 8 ' ti~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Sana Aamina Sharif
-.J
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
MIDDLE
"-
N
B BIRTH NAME. IF DIFFERENT B. BIRTH NAME (MAIDEN NAME I. IF DIFFERENT
C SURNAME AFTER MARRIAGE C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEln55 72 5862 (OPTIONAL - SEE REVERSE) 106-64-3124
. D SOCIAL SECURITY NUMBERU - - D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. New York B. Albany 12 RESIDENCE A. N Y 8. Dutchess
(STe-lE) (COUNTY) (STATE) J (COUNTY)
C. CHECK ONE TI CITY 0 TOWN 0 VILLAGE C. CHECK ONE 0 CITY 0 TOWN 0 VILLAGE
AND Alb AND P hk '
SPECIFY an7 SPECIFY oug eepsle
D STREET ADDRESS 2 4 W, Lawrence Street liP '12208 0 STREET ADDRESS 11 Sherrywood Road liP 12590
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? l"i YES 0 NO E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES l"i NO
05 / 07 / 1979 13. A. AGE 23 13.B. DATE OF BIRTH 02 /01 /1'979
MONTH DAY YEAR MONTH DAY YEAR
3. A. AGE 23
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Engineer
8. TYPE OF INDUSTRY OR BUSINESS IBM Corp.
5 PLACE OF BIRTH Canberra, Australia
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Shamshad Ahmad
8. COUNTRY OF BIRTH India
7. MOTHER
A. MAIDEN NAME Kishwar Beoum
B COUNTRY OF BIRTH India
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION Software Engineer
B. TYPE OF INDUSTRY OR BUSINESS IBM Corp.
15. PLACE OF BIRTH Middletown, New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Azmat Sharif
B. COUNTRY OF BIRTH India
17. MOTHER
A. MAIDEN NAME Rizwana Beoum
8. COUNTRY OF BIRTHlndia
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(2) 0 DEATH
(3) 0 ANNULMENT
/ /
MONTH DAY YEAR
o 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
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
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1 ST 0 0 1 ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the marri ate. n r"'t..~, .
21. SIGNATURE OF GR 22. SIGNATURE OF BRIDE ~ ~\~ ,-\'
23. ~ ' - USE CURRENT ::~:06/ 7/2002
This license authorizes the marriage in New York State of 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 CI;Q' CLI;RK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) ljlor/,a J.
{ _ 06/27/2002 TIME MONTH
SEAL SIGNATURE ~ - DATE
'-v-I M~'Mfam !bush Rd, ger Fa Is, NY 12590 09:27 ~~ 06
STREET CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED N OCCURRED 27. TYPE OF CEREMONY
~~~SM~~~~~~8~v~HJN PiH~ MO DAY YEAR 0 19""RELlGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND C
PLACE INDICATED. ,~ ',1.\$ PM 6,. 3b' c:. L. 9 ~OTHER, SPECIFY \,1 L <'t 1,1 ~\rL.
~~,Jt;~~~~T ). ~ "'-c.. ^^" flM. Q. (")~ ~ ~ ~ L +<.. ~ M TITLE :[ OI\A n. '" AA_
SIGNATURE~ ~ ~ ~~~ DATE C,- 3t'\-n1
MAILING ADDRESS
12-!> 41L.J- /H..,CieL 120AD wr.-.?\NQEa'L. ~ tv ~J' ()
STREET CITYfTOWN STATE ZIP
30. WITNESS TO CEREMONY . 31. WITNESS TO CEREMONY
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YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNTY D u r ( l-( f r; :
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY w"ft(JIt.((.,...f.P,
~"
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
NAME (PRINT)
SIGNATURE ~