097
+
!z
W
UJ
~.
o
-'
::l
o
:I:
UJ
Z
o
~
~
UJ
a
W
a:
W
Cl
<
Ii'
a:
<
:;
u.
o
~
<.:>
Ii:
'"
0:
W
t.l
W
:t
.1J
:t
;=:
1)
1)
.1J
:t
::l
::l
..
,.
l.
:3
.1J
l.
n
0:'
W
"'
:l!
:>
z
o
~
Iii
w
~
+
1E~:i W
?_o
Iii ~ f= ....
0:",;5 c:c
lii~~ CJ
::l<.:>W
~~g i!
~~15 t:
tEO(/) w
~~~ CJ
t!!~U)
~~11;
COUNTY Dutchess
CITYrrOWN Wappinger
~~J:~CRT 1368 .
~5~~J~R 97
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
.ln~hlJa FdmlJnd YOImaman
MIDDLE CUR1li!NT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
~
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Stephanie Lynn Garaffa
MIDDLE CURRENT SURNAME
1 . A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
ll.
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE You n g man
(OPTIONAL - SEE REVERSE)O 72 3086
D. SOCIAL SECURITY NUMBER 42 - -
12. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Pouahkeeosie
D STREET ADDREss31 Briarcliff Ave
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 1 31 66 5419
D. SOCIAL SECURITY NUMBER _ _ _ - __ - __ _
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND P hk .
SPECIFY oug eepsle
D STREET ADDRESS 31 Briarcliff Ave ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES '6 NO
3. A AGE ~O 3B. DATE OF BIRTH O:l / 20 / 1979
MONTH DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 28 3B. DATE OF BIRTH 01 A 1
MONTH DAY
ZIP 12603
o YEStJ NO
)(981
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION AT&T
14. EMPLOYMENT
A. USUAL OCCUPATION School Psychoiogist
B. TYPE OF I~DUSTRY OR BUSINESS Monroe Woodbury School
15. PLACE OF BIRTH Manchester, Conn
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Daniel Michael Garaffa
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN N~ME Anita Irene Joss
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
B. TYPE OF INDUSTRY OR BUSINESS Telecommunications
5. PLACE OF BIRTH Port Jefferson. NY
. (CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME John Kenneth Youngman
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Mary-Lynn Green'
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
~ YEAR
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) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
MONTH DAY
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) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say, t
as to my right to enter into the marr
21. SIGNATURE OF GROOM.
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
t the best of my knowledge and .belief that the information I provided is true
tate.
o 0
o 0
o 0
o 0
nd that I declare that no lega impediment exists
22. SIGNATURE OF BRIDE.
~
23. SUBSCRIBED AND SWORN TOII\FFIRMED B
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 CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
DATE
by New York Domestic
w
en
z r-^-.
~ { } NAME (PRINT)
:J SEAL SIGNATUR.E.
'-.t-I MAI~'lr ~f
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE 0 0 RELIGIOUS
DATE AND AT THE TIME AND AM
PLACE INDICATED. P ( () q 0 9 0 OTHER, SPECIFY
~~~t~~~~T 1) A vi D 17.... :res S TITLE OrrlC IA;V}
SIGNATURE. 'Y ~',( 7l€:::= . DATE /1> I,. I " 7
MAILING ADDRESS
2. 6 J >. ci.. n:rcfl--... "" 7 ,A,.,Ac..~/-- C/1 '7 LYO-7--
STREET CITYrrOWN' STATE ZIP
30. WITNESS TO CEREMONY 31. WITNESS TO CEREM~~Y .
NAME (PRINT) NAME (PRINT) ~ ~~
SIGNATURE. SIGNATURE. ~ ---- ...c::;;;-
YEAR
MONTH
YEAR
TIME
MONTH
09:03AM 09
PM
2009 10
30 2009
01
1 G!-'CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYO(tlJ'.~ c...
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~TOWN OF 0 VILLAGE OF
SPECIFY/fl;,1 t>;:>J"1lj ~ /""lIe..