141
+
o
0>
~~
......1;;
>-
z
u.
o
~
~
w
o
w
a:
w
i
~
w
a:
c
~
~
bi
II.
en
!z=
w
en
w
/Xl
9
::l
o
J:
en
~.
~
(;
w
a:
w
(!)
<
11:
a:
~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Pasquale Giovanni Carratu
MIDDLE CURRENT SURNAME
Dutchess
COUNTY . 'iJ .
v applnger
CITYfTOY1"3
DISTRICT 5e .
~~~I~~R 14 1
NUMBER
1. A. FULL NAME
FIRST
0-
F:!
B. BIRTH NAME. IF DIFFERENT
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
l-
S;
cr:
c
wU:
CllL
cr:
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSEUb~- (4-Ub4/
D. SOCIAL SElf.UR/l)' NUMBER D ...
NY utc/less
2. RESIDENCE A. B.
(STATE) ol. (COUNTY)
C. ~gCK ONf:ishRth CITY 0 TOWN 0 VILLAGE
SPECIFY 17e iownview Dr.
D. STREET ADDRESS ZIP
E. IS RE~gCE WITHIN LIMITS OF CIlY OR INCORPORATED {~GE? 2f
3. A. AGE 3B. DATE OF BIRTH /
MONTH DAY
4. EMPLOYMENT F' . I Ad .
A. USUAL OCCUPATION Inancla visor
Finance
B. TYPE OF INDlJ,S.TRY OR BUSINESS, b.
tjronx New T or"
5. PLACE OF BIRTH I
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER G' . C t
A NAME lovannl arra u
. Italy
B. COUNTRY OF BIRTH
7. MOTHER
125!i}0
-I
Y/f9~%
YEAR
Lo
--1
Annamaria Russo
A. MAIDEN NAME I I
B. COUNTRY OF BIRTH ta ~
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV~CE CIVIL A~ULMENT
D~TH
SUPPLEMENTAL FILE
FADM THE BRIDE I"
Dena Mane Zaccag Inl
11. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
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) (CITYICDUNTY, STATElCOUNTRY,IF NOT USA) SELF SPOUSE
B. BIRTH NAME (MAIDEN NAME)C~fF~m
c. S~~~"ft,~~~~~~~~~~s~~m-45-6186
D. SOCIAL smrrv NUMBER DuLcl,es~
12. RESIDENCE A. (STATE)" B. (COUNTY)
C. X~gCK <pjshkifP CITY 0 TOWN 0 VILLAGE
SPECIFY 178 Towlwie'w Dr. 12500
D. STREET ADDRESS ZIP
E. IS R~2fNCE WITHIN LIMITS OF CIlY OR INCORPORA~a VILLAGE'IoJR 0
13. A. AGE 3B. DATE OF BIRTH L
MONTH DAY
14. EMPLOYMENT Sonographer
A. USUAL OCCUPATION Medical
B. TYPE OF IND'PI~,""e'l3lifornia
15. PLACE OF BIRTH
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER Victor Lee Zaccaglini
A. NAME U 3 A
B. COUNTRY OF BIRTH
".
y)fft ~O
YEAR
17. MOTHER Janet Marie Honeycutt
A. MAIDEN NAME U 8 A
B. COUNTRY OF BIRTH 2
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DI(ORCE CIVIL Are'ULMENT
D'{}TH
.
..
B. HOW DID LAST MARRIAGE END? (3) 0 DIVO~ (3) CO'eNULMENT 20051 DEATH
C. DATE LAST MARRIAGE ENDED? . / /
MONTIIr 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
(1~nr~cr~) Se<afi~~TElCOUNTRY, IF NOT USA) SELF SP~E
1fi 0 0
2ND 0 0
~ 0 0
~ 0
e Information I provided t exists
a:'
w
!i
~
o
~
Iii
w
~
23. SUBSCRIBED AND SWORN TO
SIGNATURE OF TOWN OR CI CLERK ~
This license authorizes the marriage in New 'York State of the bride and groom named above by any person authorized
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 u e of a second or subsequent ceremony.
r-"-. 24. TOWN OR CI1J8IfRKc. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
SEAL SIGNATURE~ (jP'_(J,~ DATE 12/14/2009 YEAR
'-y-/ ~1!IIImII!i~Sh Ro, Wappingers Falls, NY 12590
STREET CITYITOWN STATE ZIP
~~~R~~Ri~~~ 10~O~~N~~~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME O. Y YEAR 0 0 RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
w
en
z
w
0
::J
+
~~~ W
~~~ !;i
~~z
en~::i! 0
::lOg
::i!(!) u:
!z~ ~
~~15 a:
U:~en W
15 >
..wC'j 0
t!!ffiU)
~3~
29. OFFICIANT
NAME (PRINT)
by New York Domestic
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY~
C. LOCATION OF CEREMONY
(CHECK ONE AN)' SPECIFY)
o CITY OF 11" TOWN OF 0 VILLAGE OF
SPECIFY~r J je(
P
31. WITNESS TO CEREMONY
a, (:> v td. .
::::::: ~I/O//~:~
r--
~~:~~ ~