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COUNTY Dutchess
CITY/TOW~ wappmger
DISTRICT 36ts .
NUMBER
REGISTER 1 31
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFADAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Raymond Anthony Buglione
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
"I
Lo
SUPPLEMENTAL FILE
FROM THE BRIDE
Lisa Marie Ameo
.J
1 , A, FULL NAME
11, A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
..
I'l
B, BIRTH NAME (MAIDEN NAME)~ DIFFffcENT
C. SURNAME AFTER MARRIAGE ug lone
(OPTIONAL. SEE REVERSE1I1 0- (0-4b48
D. SOCIAL SIiiQJ.FlJTY NUMBER D I>..
NY utClless
12. RESIDENCE A. B.
(STATE) 011 (COUNTY)
C. CHECK QtlI:, 0 CITY [;l. T,QWN 0 VILLAGE
AND vvappmgersr-all5
SPECIFY 5 1 Mar k~t 5t Apt A 12590
D. STREET ADDRESS !!
E. IS R~~NCE WITHIN LIMITS OF CllY OR INCORPORAffl VILLAGE?~ 0
13. A. AGe<: 3B. DATE OF BIRTH C
MONTH DAY
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE056-74-5494
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE) .L. (COUNTY)
C. CHECK ON~. . Q CITY 0 JOWWU VILLAGE
~~~CIFY vvappmgers r-alls
D. STREET ADDRESS b 1 MarKet ::>t. Apt. A ZIP '12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? .,-; YES Q.. ~%
3. A. AGE 33 3B. DATE OF BiRTH 03 / 1 Er /18
MONTH DAY YEAR
YJ98cfO
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION IT
B. TYPE OF INDU~TRY OR BVEiINES\computer consultant
5. PLACE OF BIRTH tsronx, New orK
14. EMPLOYMENT L 1 A . t t
ega SSIS an
A. USUAL OCCUPATION, L
" aw
B. TYPE OF INDUliTR'I'.,oIl.BUS[!I,!Iil'!S \1 ., k
1.,,010 ~prln8: i ew lOI
15. PLACE OF BIRTH "
(CITY,$TATE I COUNTRY IF NOT USA)
16: FATHER '
John Joseph Ameo
A. NAME U 5 A
B. COUNTRY OF BIRTH
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Raymond Buglione
B. COUNTRY OF BIRTH USA
7. MOTHER . .
A. MAIDEN NAME Marjone Zlnkman
B. COUNTRY OF BIRTH USA
1
8. NUMBER OF THIS MAR81AGE
9. ~~~~~~JlRMtn~\~8us MARRIAGES WHICH ENDED BY
DIV~RCE CIVIL AN8ULMENT
17. MOTHER
Louise Ann BocchiflO
A. MAIDEN NAME U 5 A
B. COUNTRY OF BIRTH 1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A~ULMENT
DttTH
D~TH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (~ 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? L /
MONTH 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
(MONTH, DAY, YEAR) (CITYICOUNTY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
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) (ClTYICOUNTY. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I duly swear/affirm, dep.ose and say, t
as to my right to enter into the mar
21. SIGNATURE OF GROOM~
o
o
o
o
o
o
o 0
o 0
o 0
o
ent exists
US C
23. SUBSCRIBED AND SWORN TOIAFFIR BEFORE ME
SIGNATURE OF TOWN OR CITY 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 purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY C ERK M t 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) J n . as erson
{SEAL } SIGNATURE ~
MA~tf
'-v-I
DATE
by New York Domestic
11/16/2009
DATE
, NY 12590
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 ~L1GIOUS
9 0 OTHER, SPECIFY
C. LOCATION OF CEREMONY
(CHECK ONE AND ~CIFY)
o CITY OF D(,.76WN OF 0 VILLAGE OF
;~r ~D'f~lfif};/~
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNrvI2.V/ctf-E..2S
10 CIVIL
D1
~~8t~~~~T (<Pv , ;J4 II,{ ~.$. G>rt- ~, c;Tu
SIGNATURE~ ~ ~Jt-V1,lCVt /~.A..:('A ~
MAILING ADDRESS , (,
5)-, ,-?e7&tL.5 'C fit} tZCH 117 rA-(JI-ft!,
CITY/TOWN
STREET
3D. WITNESS TO CEREMONY
NAME (PRINT) c..LyI~4-0f/7Lr~.,..
SIGNATURE~ ~~
A-H "-
TITLE !/.I- T11 () L ~ (' PfZf'CS f
DATE / J-.I t/ / 07'
c~:)'f Pt~~~1 P/Jt:. fJV
STATE / ZIP
.::::;: ~ CEREMO>' , ~Q\ \
SIGNATURE~~~l~ L(0J