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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Timothy Patrick Molon
MIDDLE CURRENT SURNAME
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
best of my knowledge and belief that the Information I provided Is t
USE CU
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage In NewY k State of the bride and groom named above by any person authorized by New York Domestic
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 onl for the purpose of a second or subsequent ceremony.
,-I'-. 24. TOWN OR CI1J8\fAKc. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINi)
11/25/20 TIME MONTH YEAR MONTH
SEAL SIGNATURE ~' DATE
MAI~MM6Ie sh Rd, Wappingers Falls, NY 12590 11 26 2009 01
'-v-I
Dutchess
COUNTY
Vvappmger
CITYrrow-r
DISTRICT 368 .
~~~I~~~R 135
NUMBER
1 . A. FULL NAME
FIRST
..
F;j
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)132-64-8958
D. SOCIAL SECf!So/ NUMBER
2. RESIDENCE A. B. uutcness
(STATE).L (COUNTY)
C. CHECK ON~ Q I,CITY 0 . TOWN 0 VILLAGE
~~CIFY I-"ougn~eepsle
43 Jackman Drive, Apt B
D. STREET ADDRESS ZIP
E. IS RES~gCE WITHIN LIMITS OF CITY OR INCORPORATED a~GE? 1 !f!
3. A. AGE 3B. DATE OF BIRTH /
MONTH OAY
12603
.,
Y/19rf1
YEAR
4. EMPLOYMENT
A USUAL OCCUPATION Teacher
. SUFSD
B. TYPE OF INDUsrR'(8~USINESS N
5. PLACE OF BIRTH ~Ol prrng, y
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A NAME Terrance James Molon
. USA
B. COUNTRY OF BIRTH
7. MOTHER N M' S rf
A. MAIDEN NAME ancys arre ca
U A
B. COUNTRY OF BIRTH I
8. NUMBER OF THIS MARRIAGE
8. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D1V~CE CIVIL ANtrLMENT
DE6TH
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) (CITYICOUNlY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(rHIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE .
Alicia Marie Pinllo
--1
11. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME),~.pIFfERENT
IVlolon
C. S~S~JNi~~~rt~~~~SE)124-68-3298
D. SOCIAL Sj;,CUflIlY NUMBER .... t ...
N Y uU Clless
12. RESIDENCE A. B.
(STATE) " (COUNTY)
C. ~5CK 'l!fougrTke:gpSJle TOWN 0 VILLAGE
SPECIFY 43 Ji::ICk.llli::Ill DI ive, Apt B 12003
D. STREET ADDRESS ZIP
or
E. IS RE~CE WITHIN LIMITS OF CITY OR INCORPORAT1ij'ILLAGE? ?3 0 YE~hh~O
13. A. AGE 3B. DATE OF BIRTH L.. ~
MONTH OA Y YEAR
14. EMPLOYMENT
Teacher
A. USUAL OCCUPATION PBC8D
B. TYPE OF IND~~WfMPgflt~~y
15. PLACE OF BIRTH
(CrrY, STATE I COUNTRY IF NOT USA)
16. FATHER Thomas Ralph Pirillo
A.NAME USA
B. COUNTRY OF BIRTH
17. MOTHER Deborah Mary Ann Canosa
A. MAIDEN NAME USA
B. COUNTRY OF BIRTH 1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D'tfRCE CIVIL A'tjULMENT
DroTH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
,.- YEAR
B. HOW DID lAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
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
(MONTH, DAY, YEAR) (CITYICOUNlY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
22. SIGNATURE OF BRIDE~
11/25/2009
YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIM
PLACE INDICATED.
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
""....... I nn In" ,....nnt!>\
28. PLACE WHERE MARRIAGE OCCURR~
A. STATE NEW YORK B. COUNrfc:trk& fu.!.
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LLAGE OF
SPECIFY
IAl~Pf d/h1f-<5
~
....
NAME (PRINi)
SIGNATURE~