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COUNTY Dutchess
CITYrrOWN Wappinger
~~~~~~ 1368
~5~:l~R 123
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Oscar Nunez
MIDDLE CURRENT SURNAME
FIRST
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
-,
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Evelina Sabatino
MIDDLE CURRENT SURNAME
~
1. A, FULL NAME
11, A, FULL NAME
FIRST
..
N
B. BIRlH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)059 72 4706
D, SOCIAL SECURITY NUMBER --
2, RESIDENCE A. NY B, Dutchess
(STATE) . (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Fishkill
0, STREET ADDRESS 222 Town View Dr ZIP 12590
E. IS RESIDENCE WllHlN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES '6 NO
3. A. AGE 38 3B. DATE OF BiRTH 10 / 28 / 1971
MONTH DAY YEAR
B, BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C, SURNAME AFTER MARRIAGE Nunez
(OPTIONAL. SEE REVERSE)1 04-74-4319
D. SOCIAL SECURITY NUMBER
12, RESIDENCE A.NY B, Dutchess
(STATE) ~ (COUNTY)
C, CHECK ONE Q CITY U TOWN 0 VILLAGE
~~~CIFY Fishklll ,
0, STREET ADDRESS222 Town View Dr
ZIP 1 LO~U
DYES "6 NO
)'977
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE?
13, A, AGE 31 3B, DATE OF BIRTH 12 ~4
MONTH DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Police Officer
B. TYPE OF INDUSTRY OR BUSINESS Law Enforcement
5. PLACE OF BIRTH Manhattan, NY
(CITY, STATE / COUNTRY IF NOT USA)
6, FATHER
A, NAME Jesus Manuel Nunez
B. COUNTRY OF BIRTH Puerto Rico
7. MOTHER
A. MAIDEN NAME Nelida Diaz
B. COUNTRY OF BIRTH Puerto Rico
8, NUMBER OF THIS MARF,lIAGE 3
14. EMPLOYMENT
A, USUAL OCCUPATION Stay At Home Mom
B, TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Queens, NY
(CITY, STATE / COUNTRY IF NOT USA)
16, FATHER
A, NAME Luigi Sabatino
'B. COUNTRY OF BIRTH1taly
17. MOTHER
A. MAIDEN NAME Luigia Giammatteo
B. COUNTRY OF BIRTH1ta1y
lB. NUMBER OF THIS MARRIAGE 1
9. ~~~~~~E"RM6'FR~/:('E<tT8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
2 0
B, HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B, HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEAlH
C, DATE LAST MARRIAGE ENDED? 11 / 06 / 2006 C, DATE LAST MARRIAGE ENDED? / /
MONTIU' DAY YEAR MONTH DAY ,',- YEAR
D, ARE ANY FORMER SPOUSE(S) ALIVE? [JYES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
to
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATElCOUNTAY, IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY/COUNTY, STATEICOUNTAY, IF NOT USA) SELF SPOUSE
11/06/2006 Queens County, Ny 0 d 1ST 0 0
02/01/1991 New York, Ny 0 6 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
est of my knowledge and belief that the information I provided is true and that I declare that 110 ~ment exists
:.-- - 22. SIGNATURE OF BRIDE~ 9Q~'~ c::t' ~I '"- ,
USE CURR USE CURRENT NAME
23, SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME 10/29/2009
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York 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 only for the purpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
DEATH
o
19, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEdTH
21, SIGNATURE OF GROOM
ATE 1 0/29/2009
in . e-rs Falls, NY 12590
STATE ZIP
27, TYP OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
TIME
MONTH
YEAR MONTH
YEAR
09:31AM
PM
10 30 2009 12 28 2009
1 }iif,CIVIL
28. PLACE WHERE MARRIAGE OCCURR~ ,
A. STATE NEW YORK B, COUNTYU iC ft6sg
C, LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
TOWN OF It VILLAGE OF
'f;!lG...E/2S Faus.
SPECIFY
SIGNATURE~