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DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Paul Anthon~ Bruno
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c; 1368 .
~~~I::~R 59
_.,.,..- -.
.,.- ..
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER 122 -48-3256
2 RESIDENCE A NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITYoCl TOWN 0 VILLAGE
~~~CIFY Wappinger
D STREET ADDRESS 218 All AnQels Hill Rd ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES'tJ NO
12 /14 /1970
MONTH DAY YEAR
3. A. AGE 38
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Sales Representative
8. TYPE OF INDUSTRY OR BUSINESS Communications
5. PLACE OF BIRTH Bronx. Ny
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Sabino Anthony Bruno
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Lorraine Mary D'Acampora
8. 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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
.-.......
,....... -. "--' -.. -....- --- --.-.,
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Ann Marie JOY
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Bruno
(OPTIONAL. SEE REVERSEb55_64_9983
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANY BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY '6 TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRES~18 All Angels HIli Rd
ZIP 12590
o YESfJ NO
;1'966
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE42 3B. DATE OF BIRTH 12 ~8
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Sales Representative
B. TYPE OF INDUSTRY OR BUSINESS Communications
15. PLACE OF BIRTHaronx, Ny .
'"(&tv, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAMEJames Joy
'B. COUNTRY OF BIRT~ S A
17. MOTHER
A. MAIDEN NAME Angie Vasti
B. COUNTRY OF BIRT~ S A
18. 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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
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) (CITYtCOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
o
o
o
1ST
2ND
3RD
4TH
I duly swear/affirm, depose
as to my right to enter into
21. SIGNATURE OF GROOM ~
o
o
o
DATE
06/
SECU
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 by New York Domestic
W Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
en 0 If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
Z ~ 24. TOWN OR Clj. CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
W { } NAME (PRINT)
o TIME MONTH YEAR MONTH
:::::i SEAL SIGNATURE ~
L- .-J MAIW~G"DIDaF.l AM 06 30 2009 08 28 2009
-v- LU IVI 12:47 PM
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDIC
YEAR
1~
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~Tt-~
C. LOCATION OF CEREMONY
(CHECK ONE AND YECIFY)
o CITY OF ~WN OF 0 VILLAGE OF
SPECIFY WA-PI' I ~fidJ
SIGNATURE~