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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Frir. ~tF!phF!n r.l Jr.hF!lo
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~~ 1368 .
~5~I~J~R 87
1. A. FULL NAME
FIRST
I"
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 059 Jl8 4922
D. SOCIAL SECURITY NUMBER ___:=!_ - ____
2. RESIDENCEA. NY B. nlltr.hF!!=:!=:
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWNotJ VILLAGE
~~~CIFY Fishkill
D. STREET ADDRESS 9 Cary Ave. ZIP 12524
E. IS RESIDENCE WITHIN LIMITS OF CllY OR INCORPORATED VILLAGE? ~ YES 0 NO
3. A. AGE 41 3B. DATE OF BIRTH 1 n / 1 ~ / 1 ~R7
MONTH OA Y YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION. Sale~
B. TYPE OF INDUSTRY OR BUSINESS Power Sports
5. PLACE OF BIRTH Pouahkeepsie. NY
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Raymond Paul Cuchelo
B. COUNTRY OF BIRTH U S A
7. MOTHER
A. MAIDEN NAME Jeanette Marie Danieli
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
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Theresa Marie Guarino
MIDDLE CURRENT SURNAME
-1
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
11. A. FULL NAME
FIRST
YEAR
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
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE r.1 Jr.heln
(OPTIONAL - SEE REVERSE)1 01 54 1989
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE ANY BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFY Fishkill
D. STREET ADDREss9 Cary Ave. ZIP 12524
E. IS RESIDENCE WITHIN LIMITS OF CllY OR INCORPORATED VILLAGE? '6 YES 0 NO
~2 )(960
DAY YEAR
13. A. AGE49
06
MONTH
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION lab Director
B. TYPE OF INDUSTRY OR BUSINESS Manufacturinq
15. PLACE OF BIRTH Poug h keeosie, NY
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Joseph James Guarino
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Theresa Mary Deluise
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 2
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? 11 / 04 / 1991
MONTH . DAY . - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ YES 0 NO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
11/04/1991 Pouqhkeepsie, Ny ~
DEATH
o
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
edge and belief that the information I provided is true
STREET
30. WITNESS TO CEREMONY
NAME (PRINT) :..J A 'M ~ ~. \) I ~r.;.::
SIGNATURE. ~~~~v\
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DATE
by New York Domestic
MONTH
YEAR
23. SUBSCRIBED AND SWORN TO/AFFIRMED 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
W Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
(/) 0 If checked, this license Is to be used only for the purpose of a second or subsequent ceremony.
Z ~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
W { } NAME (PRINT) Jo C. Masterson
o TIME MONTH DAY YEAR
::i SEAL SIGNATURE. DATE 08/14/2009
"- .-J MAIJJfiG f.r;PldRE.!is 11 30 AM
-v- LU M 01 ush Rd, Wappingers Falls, NY 12590 : 08
STREET ClTYfTOWN STATE ZIP PM
~~~R~~RT~~J 10~O~~~Nl!i~ 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 I7f CIVIL
DATE AND AT THE TIME AND "
PLACE INDICATED. 9 0 OTHER, SPECIFY
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15
2009
10
13 2009
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY-Uti/(? ~5-'J
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF Af TOWN OF 0 VILLAGE OF
SPECIFY&~(j ~~<.//
NAME (PRINT)
SIGNATURE.