065
0-
N
+
cot!!
C'?~
L{)'"
N
..-
u.
o
t!!
...
()
u:
~
w
()
w
a:
w
~
I/)
I/)
w
a:
o
o
..
~
u
W
0-
'"
cr.'
w
m
~
::>
z
o
z
<(
Iii
w
cr.
~
w
-en
z
-w
o
-::i
+
~~:i W
2-0
w~f= ....
a:"';S c(
ti;~~ 0
:;)()W
:l:Cl5 u:
!z;!;'" -
~~~ ~
ito", W
Of->
Ujtlj<30
b~'"
z::;;!;
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I duly swear/affirm, depose and say, that to the best of my knowledge and belief that the i
as to my right to enter into the marrrage state.
21. SIGNATURE OF GROOM~
USE C
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New rk 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.
,-I'-.. 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINn John C. Masterson
TIME MONTH YEAR
SEAL SIGNATURE ~ DATE 07/06/2009
I...- -J MAIWfiG f.<:;,PdRE,f?
-v- LV IVI 01 in ers Falls, NY 12590
STREET CITY/TOWN STATE ZIP
~~~R~~RT~~ IO~O~~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 ~L1GIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
COUNTY Dutchess
CITYITOWN Wappinger
~~~:~c: 1368
~~~I~~~R 65
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
r.hri!=:tcmhAr Mich::Jel Favale
MIDDLE CURRENT SURNAME
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Amanda Evans
MIDDLE CURRENT SURNAME
~
1 . A. FULL NAME
FIRST
1 1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 105-72-6562
2. RESIDENCE A. NY B. DutchASS
(STATE) (COUNTY)
C. CHECK ONE 0 CITY olJ TOWN 0 VILLAGE
~~~CIFY Hyde Park
D STREET ADDRESS 147 Pinebrook Drive ZIP 12538
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATEO VILLAGE? 0 YES"tJ NO
On / 03 /1981
MONTH OA Y YEAR
3. A. AGE ?R
3B. DATE OF BIRTH
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Favale
(OPTIONAL - SEE REVERSE061 74 8897
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE ANY B.Dutchess
(STATE) (COUNTY)
c. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Hyde Park
D. STREETADDREss147 Pinebrook Drive
ZIP 12538
o YES~ NO
.%983
YEAR
4, EMPLOYMENT
A. USUAL OCCUPATION Sheet Metal Worker
B. TYPE OF INDUSTRY OR BUSINESS Construction
5. PLACE OF BIRTH Poughkeepsie. NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME .Joseph Vincent Favale
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Eileen McGuckin
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
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE25 3B. DATE OF BIRTH 08 ~O
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Assistant Director
B. TYPE OF INDUSTRY OR BUSINESS Higher Education
15, PLACE OF BIRTH Poughkeepsie, NY
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAMEMichael C. Evans
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Kathleen Mary DiTommaso
B. COUNTRY OF BIRTHU S A
1B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS,MARRIAGES
A. NUMBER. OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
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
B, HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH OA Y
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
o 0
o 0
o 0
o 0
at no legal impediment exists
DATE 07/06/2009
by New York Domestic
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) (CITY/COUNTY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
MONTH
YEAR
02:47~~ 07
04 2009
07
2009
09
26. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
ltJ~~i;
A, STATE NEW YORK B. COUNTY
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~ILLAGE OF
SPECIFY t\1 C\ ~l (1~ D.. e.-
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) 'K