143
23. SUBSCRIBED AND SWOR
SIGNATURE OF TOWN OR CI
This license authorizes the marriage in New' York State of the bride and groom named above by any person authorized
W Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
en 0 If checked, this license Is to be used only for the purpose of a second or subsequent ceremony.
Z ~ 24. TOWN OR CI'T'( C~ERKC M sterson 25. A. SOLEMNIZATION PERIOD BEGINS
W NAME (PRINT) JOnn , a
~ {SEAL} SIGNATURE ~ ~ DATE 12/17/2009
'-v-I MAI~M~Cfl~ sh Rd, Wappingers Falls, NY 12590 03:19~~ 12
STREET STATE ZIP
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE
SONS NAMED ABOVE 1 CIVIL
DATE AND AT THE
PLACE INDICATED.
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Carlos Alberto Yannuzzi
Dutchess
COUNTY
VVapplnger
CITYITO~
DISTRICT 68 .
~~~I~~~R 143
NUMBER
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
1. A. FULL NAME
FIRST
MIOOLE
CURRENT SURNAME
L 0 SUPPLEMENTAL FILE
~
..
f;j
B. BIRTH NAME, IF OIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE083-70-5844
O. SOCIAL SE<;.uRIl)' NUMBER
NY uutcness
2. RESIDENCE A. B.
(STATE) .t. (COUNTY)
C. ~5cKONFishk1\1 CITY 0 TOWN 0 VILLAGE
SPECIFY 154 l\Jorth River Dr
D. STREET ADDRESS ZIP
E. IS RE~9NCE WITHIN LIMITS OF CIlY OR INCORPORATED .f1fGE? 1 f
3. A. AGE 3B. DATE OF BIRTH /
MONTH DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Teacher
Education
B. TYPE OF INDU~R~ ~SIPrYfown N
5. PLACE OF BIRTH 0 a I y
(CrrY, STATE I COUNTRY IF NOT USA)
6. FATHER Y'
A. NAME Giuseppe Alberto annuzzl
l,;uoa
B. COUNTRY OF BIRTH
.,
/1910
YEAR
FROM TH.E BRIDE
Elsa Susana Reyes
11, A. FULL NAME
FIRST lIJIlPLE P I CURRENT SURNAME
~eyes 0 ar
B. BIRTH NAME (MAIDEN NAME)'f ~lffR\J2z1
C. SVS~:1fN~tt~~~EA~~C~AsE()5 1-76-11B1
O. SOCIALS~NUMBER DuLdll:::$&
12. RESIDENCE A. (STATE)" e, (COUNTY)
C. ~5cK'PishkilP CITY 0 TOWN 0 VILLAGE
SPECIFY 104 North River Dr 12508
o. STREET ADDRESS ZIP ...
E. IS R~~NCE WITHIN LIMITS OF CITY OR INCORPORA~'VILLAGE?M 0 Y~erO
13. A. AGE 3B. DATE OF BIRTH L C
MONTH DAY YEAR
14. EMPLOYMENT Associate Product Manager
A. USUAL OCCUPATION ReLail
B. TYPE OF INDlfiWT~R~SS
15. PLACE OF BIRTH
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER J R es
ose ey
A. NAME Pt::1 u
B. COUNTRY OF BIRTH
17. MOTHER Alejandrina Polar
A. MAIDEN NAME Pt::1 u
B. COUNTRY OF BIRTH 2
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DtyORCE CIVIL A~ULMENT
D~TH
12508
7. MOTHER Gild C. A uila
A, MAIDEN NAME a 9
l,;uoa
B. COUNTRY OF BIRTH I
8. NUMBER OF THIS MARRIAGE
9. ~~~~~d'~R~FRPh')Rlf8us MARRIAGES WHICH ENDED BY
DIVYfCE CIVIL AN~ULMENT
D"OTH
".
B. HOW DID LAST MARRIAGE END? (3) 0 DIV~ (3) ~^rULMENT 1 9981 DEATH
C. DATE LAST MARRIAGE ENDED? MONT"" / DAY .(. YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
ffl'frfff g~) Br6Rf.'Lf~JMr~Y' IF NOT USA) ~F SPOUSE
1ST I 0 0
2ND 0 0
3RD 0 0
o 0
hat no legal impediment exists
~
12/17/2009
ATE
by New Yorik Domestic
TIME
B. HOW 010 LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEAJli
YEAR
MONTH
YEAR
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CrrYICOUNTY, STATElCOUNTRY.IF NOT USA) SELF SPOUSE
1ST
21\(0
3RD
4TH
I duly swear/affirm, dep.ose and
as to my right to enter Into
21. SIGNATURE OF GR
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02
28. PLACE WHERE MARRIAGE OCC~
A. STATE NEW YORK B. COU~;';t ,.(uS
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF ~VILLAGE OF
SPECIFY WA1>P'i~"t"\06 W
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NAME (PRINT)
SIGNATURE~