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COUNTY Dutchess
CITY TOWN Wappinger
1368
41
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Giang WU
MIDDLE CURRENT SURNAME
FIRST
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
DISTRICT
NUMBER
REGISTER
NUMBER
&~t
"
6 - }. t70(
L C SUPPLEMENTAL FILE
FROM THE BRIDE
~~}!~imin Zha~&ENT SURNAME
~
A FUll NAME
11 A. FULL NAME
FIRST
0-
N
B BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 040-92-7960
D SOCIAL SECURITY NUMBER ___ __ ____
2 RESIDENCE A N Y B Dutchess
(STATE) (COUNTY)
C CHECK ONE D CITY oIrOWN D VILLAGE
AND W .
SPECIFY applnger
D STREET ADDRESS 510 Malonev Road H -23 ZIP 12603
8 BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE 7hang
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER
12. RESIDENCE A N Y
(STATE)
C. CHECK ONE D CITY D ~OWN D
AND W .
SPECIFY applnger
o STREET ADDRESS 510 Malonev Road H -23
Dutchess
(COUNTY)
VILLAGE
ZIP
12603
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3 A AGE ~n 3B. DATE OF BIRTH n~ /
MONTH
DYES cY'NO E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? eYES D"NO
?R / ~!=l7113 A. AGE ~n 13B. DATE OF BIRTH n~ /?R / i!=l7 i
DAY YEAR MONTH DA Y YEAR
14 EMPLOYMENT
A. USUAL OCCUPATION Sales Specialist
B. TYPE OF INDUSTRY OR BUSINESS I B M Corp. - Canada
15. PLACE OF BIRTH Shanahai. China
(CITY, STATfCOUNTRY IF NOT USA)
16. FATHER
A. NAME Jiaju ZhanQ
B. COUNTRY OF BIRTH China
4. EMPLOYMENT
A. USUAL OCCUPATION Engineer
B. TYPE OF INDUSTRY OR BUSINESS Ibm Corp.
5. PLACE OF BIRTH Shanahai China
(CITY, STA1f/COUNTRY IF NOT USA)
6 FATHER
A. NAME ChangzhenQ Wu
B COUNTRY OF BIRTH China
7. MOTHER
A. MAIDEN NAME Mei)(j,::m Y;:lno
B COUNTRY OF BIRTH China
8 NUMBER OF THIS MARRIAGE 2
17 MOTHER
A. MAIDEN NAME Xlleli Ye
B COUNTRY OF BIRTH China
1
18. NUMBER OF THIS MARRIAGE
9 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) O~IVORCE (3) D ANNULMENT (2) D DEATH B. HOW DID LAST MARRIAGE END? (3) D DIVORCE (3) D ANNULMENT (2) D DEATH
C DATE LAST MARRIAGE ENDED? 12/ 08 / 2000 c. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR MONTH DA Y
D. ARE ANY FORMER SPOUSE(S) ALIVE? D o(ES D NO D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D NO
10 IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH. DAY, YEAR) (CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
12/08/2000 Shanghai China 0'" C 1ST D 0
D 0 2ND D D
D 0 3RD D 0
o 0 4TH [J
nowledge and belief that the information I provided is true and that I declare that no legal impediment exists
"' S:4~~~
22. SIGNATURE OF BRIDE ~L
SE CUf.lRENT NAM USE CURRENT NAME .r
.~.
DEATH
o
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
YEAR
1ST
2ND
3RD
4TH
I. being duly sworn, depose and say, that to th
as to my right to enter into the marriage state.
21 SIGNATURE OF GROOM ~
DATE
04/22/2002
w
CJ)
Z
W
()
...J
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNA TURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State f the bride and groom named above by any person authorized
Relations Law 911 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
aria J.
by New York Domestic
TIME
MONTH
~
{ } NAME (PRINT)
SEAL SIGNATU~
'-v-I MAIL~a 'Nftd'drebus
DATE 04/22/200
ppinQer Falls, NY 12590
CtTY:TQWN STATE ZIP
27. TYPE OF CEREMONY
1~IL
AM
12:24'M
04
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
28. PLACE WHERE MARRIAGE OCCURRED
A STATE NEW YORK B. COUNT~\.( TCIf~
C LOCATiON OF CEREMONY
(CHECK ONE AND7ECIFY)
C CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY W/tPP;;1:;6'i tZ--
o C RELIGIOUS
9 [J OTHER. SPECIFY
STREET
30. WITNESS TO CEREMONY
NAME (PRINT) -:2' t?~~. ...,.
SIGNATURE ~
DOH.98 (11/98)
ZIP
31 WITNESS TO CEREMONY
Q;
(~.
fJ.Au
Q~
2A.~
NAME (PRINT)
SIGNATURE ~ .