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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE-GROOM
Guy Muller
Dutchess
COUNTY W -
~pplflyt:r
CITY/TO'tf~68
DISTRICT I ~
~~~'~~~R42
NUMBER
A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
"-
N
BIRTH NAME. IF DIFFERENT
C S~~~~~JN~LT~~~t~~e~~SE)115-54-5546
o SOCIAL SE~W'ijPk
2 RESIDENCE A.
Dutchess
(STATE)..I B. (COUNTY)
C ~~~CK 01Vappm~evr 0 TOWN 0 VILLAGE
SPECIFY 1668 Route 9 Apt 8 G
o STREET ADDRESS
12590
ZIP
.,.
E IS R~~NCE WITHiN LIMITS OF CITY OR INCORPORATEmLAGE? 240 YES ~~cg
3 A AGE 3B. DATE OF BIRTH /' ~
MONTH DAY YEAR
4. EMPLOYMENT
Police Detective
A. USUAL OCCUPATION Nys Child Protective
B TYPE OF IND~HlV'9'alff(NE;ty New Tort
PLACE OF BIRTH '
(CITY, STATE/COUNTRY IF NOT USA)
6 FATHER Armando Muller
A. NAME N.
Icaragua
B COUNTRY OF BIRTH
7. MOTHER
Barbara Tuttle
USA
B COUNTRY OF BIRTH 1
8 NUMBER OF THIS MARRIAGE
A. MAIDEN NAME
9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL Atl'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
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1ST
2ND
3RD
4TH
I, being duly sworn, depose and
as to my right to enter into the m
21 SIGNATURE OF GROOM ~
23
o
o
o
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Michelle De Giacomo
~
11 A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B BIRTH NAME (MAIDEN NAME). M~U~1!H
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEi068-58-::iU4::i
o SOCIAL S~~eRITwY N~~OBEIL
N Y t rK Dutchess
12 RESIDENCE A B
(STATE)" (COUNTY)
C. CHECK CH:, D.~ITY 0 TOWN 0 VILLAGE
AND Wappinger
SPECIFY 1668 Route 9 A t. a G
o STREET ADDRESS P
12590
ZIP
""
YJIH2NO
YEAR
E IS RE~~NCE WITHIN LIMITS OF CITY OR INCORPORATEb~LLAGE? 0
13. A AGE 13.B. DATE OF BIRTH ~1
MONTH DAY
14. EMPLOYMENT P . t f S I -
A. USUAL OCCUPATION OIn 0 a es SupeMsor
, Kohrs
B TYPE OF IND'fjTRY ~BUShE~~
15. PLACE OF BIRTH ew OC e e, New YOrk
(CITY, STATE/COUNTRY IF NOT USA)
16 FATHER .
A. NAMEMlchael De Giacomo
B. COUNTRY OF BIRT~ S A
17. MOTHER
A. MAIDEN NAME Sharon Boettner
B. COUNTRY OF BIRT~ S ~
lB. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DfiORCE CIVIL A~ULMENT
D{fTH
B. HOW DID LAST MARRIAGE END? (3/:J 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
o
o
o
DATE
by New York Domestic
w
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te of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies with 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 ~rcf~KJ. 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
~
{ SEAL}
'-y-I
TIME
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON
MONTH
DAY
YEAR
YEAR
MONTH
04/24/2002
TE
r Falls, NY 12590
23 2002
1: 3
AM
PM
25
04
2002 06
ZIP
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
STATE
27 TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
1~
28 PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTy:t)l/ic.m3,\
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
C CITY OF ~N OF 0 VILLAGE OF
SPECIFY f6 u.(, J.i-~1.. ,?Js i f
29. OFFICIANT
NAME (PRINT)
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
NAME (PRINT) .,
SIGNATURE ~