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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFADA VIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GBOOM
Jia Xu
Dutchess
CO~NTY Wappinger
CITY!TOW~
DISTRICTI,",68
~~~I~~~R75
NUMBER
1 A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
"-
;;;
BIRTH NAME. IF DIFFERENT
C s~~~~~N~LTE~~:~~e~~SE~ 06-86-7 137
o SOCIAL SE~~\~l~Htk uUlchess
2 RESIDENCE A. (STATE)~ B. (COUNTY)
C ~~6CK O'WapPlh~~r 0 TOWN 0 VILLAGE
SPECIFY
25 C Sctjrburough Ltjrlt:
o STREET ADDRESS ZIP
.,
12590
E IS R~NCE WITHiN LIMITS OF CITY OR INCORPORATED1VbLAGE? A 2 0 YES kh~~
3. A. AGE 38. OATE OF BIRTH L ~
MONTH DAY YEAR
4. EMPLOYMENT M ft. M d' S'" . f' f
u I e la peela IS
A. USUAL OCCUPATION Lab Vofl
8. TYPE OF IND~TFlY- OR B~f!.IiSS
5. PLACE OF BIRTH elJlng, Ina
(CITY, STATE/COUNTRY IF NOT USA)
6 FATHER Kunxi XU
A. NAME C....
IIlnB
B. COUNTRY OF BIRTH
7, MOTHER Y I Zh
u an ou
A, MAIDEN NAME
China
B COUNTRY OF BIRTH J
8. NUMBER OF THIS MARRIAGE
9 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVfiRCE CIVIL A~ULMENT
D'(tTH
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 STA TE USE ONL Y)
I
1Jl1L
If ) I''p ~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Wet Zou
.-J
11. A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B BIRTH NAME (MAIDEN NAME)'~~lJERENT
C. S~~~~~N~LTE~~A~~e~~sd336-50-9592
o SOCIAL SfiC~RITY f'J<J)AB<Ji_ D' ~ h
New Tone:: UIC ess
12. RESIDENCE A (STATE) v' B (COUNTY)
C, ~~6CK WapptngeY 0 TOWN 0 VILLAGE
SPECIFY 25 C SCarbutOlJ I. Laile
D. STREET ADDRESS 9
""
E. IS R~\jNCE WITHIN LIMITS OF CITY OR INCORPORAT'~LLAGE? 06 0 Y'1"cFttO
13. A. AGE 13.B, DATE OF BIRTH L ~
MONTH DAY YEAR
14, EMPLOYMENT Engineer
A, USUAL OCCUPATION f _ B. M.
B. TYPE OF IND~frnfiM~S~fna
15. PLACE OF BIRTH '
(CITY, STATE/COUNTRY IF NOT USA)
16, FATHER Zh.' Z
IXtn, ou
A, NAME Ct,;Ul:2
8. COUNTRY OF BIRTH
17, MOTHER X' X
A, MAIDEN NAME ueJuan, u
(;htna
8. COUNTRY OF BIRTH 1
18. NUMBER OF THIS MARRIAGE
19, PREVIOUS MARRIAGES
A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DljORCE CIVIL A~ULMENT
D'tfH
8. 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
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
ffi
aJ
:;;
::J
Z
o
z
<{
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w
w
:0
(f)
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 C
3RD 0 0 3RD 0 0
4TH 0 0 4TH U 0
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I providBd is true and that 1 declare that no legal impediment exists
as to my right to enter into the marriage state, "
//~
21 SIGNATURE OF GROOM ~ L_
22, SIGNATURE OF BRIDE ~ ~tLUl.et '
USE CURRENT NAME 06/06/2002
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York St of the bride and groom named above by any person authorized by New York Domestic
Relations Law 911 to perform marriage ceremonies within ew 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 CC;18rf~K 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
w
en
z
w
U
..J
,-^-.,
{ SEAL }
'-y-I
06/06/2002
DATE
Falls, NY 12590
1:11
AM
PM
06
05 2002
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER~
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
TIME
MONTH
YEAR
MONTH
YEAR
07
2002 08
CITY,TOWN STATE
26. SOLEMNIZATION OCCURRED 27 TYPE OF CEREMONY
TIME MO DAY YEAR 0 0 RELIGIOUS 1 ~VIL
S' 2. 0 /
PM QIv () 7 20 Q t 9 0 OTHER, SPECIFY
~~= "'ce (OIJ)/J fIi~~ ~
__ ilL_ DATE (; -7 ' 6 1-
;4/J ~~tI'1 MJ,.J/ r oR (t. t2:: () z..
29 OFFICIANT
NAME (PRINTICy;- ~
SIGNATURE ~ v:iJ1Ltm
MAILING ADDRESS
?u,fJq(- (~7
STREET CITY TOWN
30. WITNESS TO CEREMONY I
NAME (PRINT) YulAn 2 10 t(
,-it 'f
SIGNATURE ~ -.i:tJ ;;!,' ':;
DOH-9B (11/98)
ZIP
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY 1)1JTCf(,{'9'
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN F r::J
SPECIFY~ ' {,)j
Pc
VILLAGE OF
STATE
(>NK-
SIGNATURE ~