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COUNTY Dutchess
CITYfTOWN Wappinqer
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1. A FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
.Jack Columbano
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(TH/S SPACE FOR STATE USE ONLY)
I
L 0 SUPPLEMENTAL FILE
-.J
affidavit
FIRST
FROM THE BRIDE
11. A. FULL NAME FIRST Rosa,11D~j Moran VC~~~E~T SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Baffi
c. SURNAME AFTER MARRIAGE Columbano
(OPTIONAL - SEE REVERSE)070 54 8933
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE A, NY B.9t:ftel':te55 *Queens
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Flushinq
D. STREET ADDREss65-25 Apt 5a 160thStreet
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER 131-62 -0982
2. RESIDENCEA. NY B. 8ti~* Queens
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND FI h'
SPECIFY US Ing
o STREET ADDRESS 65-25 Apt 5a16oth Street ZIP 11365
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES '6 NO
08 / 25 / 1963
MONTH DAY YEAR
ZIP11365
o YES tJ NO
/1'969
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13, A. AGE 39 3B. DATE OF BIRTH 11 ~ 6
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Legal Secretary
8. TYPE OF INDUSTRY OR BUSINESS Adminstrative
15, PLACE OF BIRTH Brooklyn, New York
(CITY, STATE / COUNTRY IF NOT USA)
3. A. AGE 4fl
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Auto Mechainic
B. TYPE OF INDUSTRY OR BUSINESS Auto Motive
5. PLACE OF BIRTH Brooklyn, Ny
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Albert Columbano
8. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Maria Caputo
B. COUNTRY OF BIRTH Italy
8. NUMBER OF THIS MARRIAGE 2
16, FATHER
A. NAME James R Baffi
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Frances E. Landolfa
B. COUNTRY OF BIRTHU SA
18. NUMBER OF THIS MARRIAGE 2
DEATH
o
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 05 / 09 / 2001
MONT~ DAY' - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? LJ YES 0 NO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
05/09/2001 Queens, New York r!1
Of
!
!
/
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) d DIVORCE (3) 0 ANNULMENT
c. DATE LAST MARRIAGE ENDED? 03/ 24 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? [YYES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
03/24/2000 Carmel, New York 0 d 1ST
o 0 2ND
o 0 3RD
o 0 4TH
knowledge and belief that the information 1 provided is true and thJ1t I d
/
DEATH
o
(2) 0 DEATH
2000 '
YEAR
1ST
2ND
3RD
4TH
I duly swear/affirm, depos
as to my right to enter into
21. SIGNATURE OF GROOM~
23. SUBSCRIBED AND SWO TO/AFFIRMED B
SIGNATURE OF TOWN 0 CITY CLERK ~
This license authorizes the marria in New York State of the bride and groDm named above by any pe
W Relations Law ~11 to perlor . ge ceremonies within New York State, THIS LICENSE VALID IN NEW YORK STATE NLY.
en 0 If checked, this license is to be used only for the purpose of a second Dr subsequent ceremony.
Z ~ 24. TOWN OR CITY CLERK 25. A SOLEMNIZATION PERIOD BEGINS
W { } NAME (PRINT) J . Ma terson
(.) TIME MONTH YEAR
::i SEAL SIGNATURE~ ATE 08/31/2009
\-. -J MAILJ.tj,G f,QD,lFjE e .
-v- LU IVI a n el's Falls, NY 12590
STREET CITYITOWN STATE ZIP
~~~R~~RT~~J IO~O~~N~:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 00 RELIGIOUS 1 ~CIVIL
DATE AND AT THE TIME AND AM
W PLACE INDICATED. PM 9 0 OTHER, SPECIFY
....
ee ~~~:~~~~~; n'J(!~.U 'Z> (r1~
(.)
~.... SIGNATURE~~1. ALA. "
MAILING ADDRESS ~
a: ~/~ ~.3btfIVF HAs,P~r#
w STREET CITYfTOWN
(.) 30. WITNESS TO CEREMONY
by New York Domestic
MONTH
YEAR
01 :03~~ 09
10
30 2009
01
2009
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY f\,II/SSRt{
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
-D CITY OF 0 TOWN OF ~ILLAGE OF
NAME (PRINT)
SIGNATURE~
SPECIFY 'F tt.e ~ PI' A! -r
n"u~ag tnfJ ,,>,,n,;;\
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Affidavit for Correction of Marriage Record
FOR OFFICIAL USE ONLY
State File #
STATE OF
Dw) lpn (\ \(
(JA-~S~
} SS:
District #
Date Completed:
Local Register #
COUNTY OF
1. Names: Jnt Jl CO/I j m tnno and 'K O:x:ln (It> ~)V (lJ.r\ V () I p~
(Groom - Full Name) (Bride - Full aiden Name)
2. Address: ~ 6 - 2 ~ Apt C) A J l no--/dJ '- -=stve.e..-+ 1 LVfSh rnp ell!}! D':\ lJ ~ 11?l DS'
(Street Address) (State) (Zip Code)
3. Marriage License 0
issued by Cityrr own: UJ (ll.{) iJI rg if 4. Date of Marriage: I 0 - 2. L/ - 2- 00 - (
5. List Items to Be Corrected:
Item Number
M It DOES Appear (list exactly)
M It SHOULD Appear (list exactly)
6. Documentation Submitted:
7. Explanation for Errors: (Explanation must specifically address how and why each error occurred. Vague or incomplete answers will not be interpreted in your favor)
Under penalty of perjury, I do hereby swear or affirm that the statements made herein are true and correct to the best of my knowledge and belief.
This affidavit with supporting documentation is being made for the purpose avin the record of marriage show the true facts and this affidavit will
become a permanent record. The marriage record is filed with the State 0 ew York.
Subscribed and sworn to
(affirmed) before me this
~
Notary Public ~
if
day of &~
BRUCE SONTAG
Yorll
Qualified In Nassau County 13'
Commission expires August 28. 20
QJo/6
DOH.1827 (1/09)
Page 1 of 2
TOWN CLERK
Chris Masterson
TOWN SUPERVISOR
Christopher 1. Colsey
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
WWW.TOWNOFWAPPINGER.US
(845) 297-4158 - Main
(845) 297-5771 - Direct
(845) 298-]478 - Fax
TOWN BOARD
William H. Beale
Vincent Bettina
Ismay Czamiecki
Joseph P. Paoloni
February 25,2010
NYS Department of Health
Vital Records Section
Registration Unit
P.O. Box 2602
Albany, New York 12220-2602
Dear Linda Ortiz
Please fmd enclosed DOH-1827 -Affidavit for Correction of Marriage Record for
Jack Columbano and Rosanne Moran Volpe, married 10/24/2009. Groom Section
2B reads "Dutchess" and it should read "Queens". Bride Section 12B reads
"Dutchess" and it should read "Queens". Please fmd your letter enclosed, as you
requested.
Please contact me at my office, (845) 297-5771, if there are any problems.
Sincerely,
J n C. Masterson
own Clerk
Town of Wappinger
JCM/cf
STATE OF NEW YORK
DEPARTMENT OF HEALTH
Corning Tower The Governor Nelson A. Rockefeller Empire State Plaza Albany, New York 12237
Richard F. Daines, M.D.
Commissioner
James W. Clyne, Jr.
Executive Deputy Commissioner
February 11, 2010
John C Masterson
Town Clerk
20 Middlebush Road
Wappingers Falls NY 12590
Re: Jack Columbano & Rosanne Moran Volpe - DOM 10/24/2009
Dear City/Town Clerk,
Since the law has changed allowing Clerks to correct marriage records the Registration Unit has put
together a packet of instructions and examples for clerks to correct the Affidavit, License and Certificate of
Marriage (form DOH-98).
Please follow the attached Instruction's when correcting or annotating the Affidavit, License and
Certificate of Marriage. Please note we only annotate the affidavit portion of the Marriage License, we do
not remove, change, replace, add to or in any other way change any information in the Affidavit Section.
(See page 1.)
In order for us to annotate the affidavit portion of the marriage license we need the attached Affidavit for
Correction of Marriage Record (DOH-1827) completed, signed and notarized by the bride and groom. The clerk
cannot sign for the bride and groom. Please return this letter with the completed affidavit.
If you have any questions or need assistance, please contact the Corrections Unit at the address below or
by phone (518) 474-2013.
Thank You,
Linda Ortiz
NYS Department of Health
Vital Records/Correction Unit
PO Box 260
Albany NY 12220-2602
Enc: Instruction to correct the Marriage License, Affidavit to Correct the Marriage (DOH-1827) and Examples.
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
CHRISTOPHER J. COLSEY
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
WILLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
October 30, 2009
NYS Department of Health
Vital Records Section
Registration Unit
P.O. Box 2602
Albany, New York 12220-2602
Dear Mr. Carucci
Please Imd enclosed DOH-1827 -Affidavit for Correction of Marriage Record for
Jack Columbano and Rosanne Moran Volpe married 10/24/2009. In the Groom
Section 2 B it reads "Dutchess" it should be "Queens" also for the Bride Section 12
B it reads "Dutchess" and should be "Queens". Enclosed please fmd a copy of the
corrected license.
Please contact me at my office, (845) 297-5771, if there are any problems.
Sincerely,
II ,"i
('J1J~tzjJc/~
Christine Fulton
Deputy Town Clerk
Town of \Vappinger
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
Affidavit for Correction of Marriage Record
FOR OFFICIAL USE ONLY
State File #
COUNTY OF
} 55,
District #
Date Completed:
Local Register #
STATE OF
1. Names:
JocJ- C:()luml7}3.JiO
(Groom - Full Name)
and
'lLOSLlX'l ne- ffiD (().%l
(Bride - Full Maiden Name)
\{nlp€' -
I (j~g 0
(Zip Code)
2 Address: /j) ~- d. S Apt ~ J too--tn.Sf-- .
(Street Address)
3. Marriage License .
issued by Cityrrown: Mpp\rq.i
5. List Items to Be Corrected:
-fYt~ nmdMS N'~
(State)
4. Date of Marriage: ) 0 . a C/ - dOcel .
Item Number
As It DOES Appear (list exactly)
As It SHOULD Appear (list exactly)
O1.b
l~b
'een~.
e. €.Yl '7:>
6. Documentation Submitted:
7. Explanation for Errors: (Explanation must specifically address how and why each error occurred. Vague or incomplete answers will not b~ interpreted in your favor)
-.LI -Gr[ C YYY\ s-\ o...Ke.-
Under penalty of perjury, I do hereby swear or affirm that the statements made herein are true and correct to the best of my knowledge and belief.
This affidavit with supporting documentation is being made for the purpose of having the record of marriage show the true facts and this affidavit will
become a permanent record. The marriage record is filed with the State of New York.
.(I~~
1X~ lOt..J...)n C..J-ex- \L
-Wwn Of WCifpr):y
~
Signature of Husband
~
Notary Public
day of
Signature of Wife
~~
';<Pt7f
Subscribed and swom to
(affirmed) before me this
DOH-1827 (1/09)
BARBARA: .
Public, Slllt.
. o. t.,
Dutchess COil, /J
My Commission EIPire6"*j' I~M!'f
Page 1 of 2