Loading...
055 0. N + f- Z W UJ W '" " --' => o J: UJ Z o f= ~ f- UJ a w a: w Cl .. a: a: ..' ::!i u. o w !;( <.l ii: f= a: w <.l w a: w ~ UJ UJ w a: " " .. it u W 0- UJ 0:' w III ::!i :J Z C Z .. to w ~ + ~~~ W tii~~ to- ~ffiz < gJd~ 0 ::!iCl5 u:: !z;!;UJ - ~~~ ti: !toUJ W Of-> 0 w~C\ bffi'" Z~;!; ~ I A II: Ut- NI:W YUHI\ DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM FIRST Ph~!~~LEAdrian D~~~~NTSURNAME COUNTY Dutchess CITYfTOWN Wappinger ~~~:~c~ 1368 ~~~I:~~R 55 1 . A. FULL NAME B. BIRTH NAME, IF DIFFERENT C. SURNAME AFTER MARRIAGE (OPTIONAL - SEE REVERSE)116 52 7663 D. SOCIAL SECURITY NUMBER -- 2. RESIDENCE A. NY B. Dutchess (STATE) (COUNTY) C. CHECK ONE 0 CITY 0 TOWN~ VILLAGE ~~~CIFY Hvde Park o STREET ADDRESS 26 Mansion Dr, ZIP 12538 E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? tJ YES 0 NO 3. A. AGE 50 3B. DATE OF BIRTH 1 0 / 22 / 1958 MONTH DAY YEAR 4. EMPLOYMENT A. USUAL OCCUPATION Professional ManaQer 8. TYPE OF INDUSTRY OR BUSINESS Automotive 5. PLACE OF BIRTH Queens, New York (CITY, STATE / COUNTRY IF NOT USA) 6. FATHER A. NAME James F. Dolce B. COUNTRY OF BIRTH USA 7. MOTHER A. MAIDEN NAME Alice May Cutler B. COUNTRY OF BIRTH USA 8. NUMBER OF THIS MARRIAGE 2 9. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT 1 0 B. HOW DID LAST MARRIAGE END? (3) t1 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH C. DATE LAST MARRIAGE ENDED? 12 / 04 / 2006 MONT~ 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 12/04/2006 Albany, New York ~ DEATH o (THIS SPACE FOR STATE USE ONLY) L 0 SUPPLEMENTAL FILE FROM THE BRIDE Anne Marie Nolan MIDDLE CURRENT SURNAME ~ 11. A. FULL NAME FIRST B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT C. SURNAME AFTER MARRIAGE Nolan-Dolce (OPTIONAL - SEE REVERSE)113_54_0279 D. SOCIAL SECURITY NUMBER 12. RESIDENCE ANY BDutchess (STATE) J.. (COUNTY) C. CHECK ONE 0 CITY U TOWN 0 VILLAGE ~~~CIFY East Fishkill D. STREET ADDRESS6 Mornlngslde Dr. ZIP 12b90 DYES "6 NO ,.%962 YEAR E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 13. A. AGE46 3B. DATE OF BIRTH 06 /f0 MONTH DAY 14. EMPLOYMENT A. USUAL OCCUPATION School Counciler B. TYPE OF INDUSTRY OR BUSINESS Arlington 15. PLACE OF BIRTH Queens, New York (CITY, STATE / COUNTRY IF NOT USA) 16. FATHER A. NAME Michael Joseph Nolan 'B. COUNTRY OF BIRTHU S A 17. MOTHER A MAIDEN NAME Santa Carmela Sturiale 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 DEATH o (3) 0 ANNULMENT (2) 0 DEATH / / ~ 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 o o o o 0 o 0 o 0 o 0 that I declare that no lega impediment exists -/f~ 1ST 2ND 3RD 4TH I duly swear/affirm, depose and say, that to the e as to my right to enter into the marnage st 21. SIGNATURE OF GROOM~ 23. SUBSCRIBED AND SWORN TO/AFFIRMED BEF 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 !i11 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 n o o W UJ Z W o ::::i ~ { } NAME (PRINT) SEAL SIGNATURE ~ '-.-I MAI~~ ~f STREET I CERTIFY THAT I SOLEMNIZED THE MARRIAGE OF THE PER. SONS NAMED ABOVE ON THE ()A TE AND AT THE TIME AND PLACE INDICATED. DATE 06/08/2009 by New York Domestic TIME MONTH YEAR DATE 06/08/2009 ers Falls, NY 12590 CITYrrOWN STATE ZIP 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY TIME MO. DAY YEAR oX:i RELIGIOUS AM 2: 30PM 7/12/09 90 OTHER, SPECIFY 29. OFFICIANT NAME (PRINT) AM 03:22PM 07 2009 06 09 2009 08 28. PLACE WHERE MARRIAGE OCCURRED 10 CIVIL A. STATE NEW YORK B. COUNTY Dutchess C. LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) o CITY OF ~ TOWN OF 0 VILLAGE OF SPECIFY ~ ~~..'-I)~~/- V DATE TITLE Catholic Priest Joseph P. LaMorte A~.~ ~et poughkeepsie. CITYfTOWN New York STATE SIGNATURE ~ MAILING ADDRESS 775 Main STREET 30. WITNESS TO CEREMONY NAME (PRINT) SIGNATURE~ DOH-98 (0312006) Maximillian Dolce .~D~ 7/12/09 12603 ZIP 31. WITNESS TO CEREMONY NAME (PRINT) SIGNATURE~ Da~Marie Nolan ~.-- ~ tv