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COUNTY Dutchess
CITY/TOWN WappinQer
~~J~~~T 1368
~B~~J~R 52
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDA VIT, LICENSE and
CERTIFICA TE OF
MARRIAGE
FROM THE GROOM
Mark Douglas Silano. JR.
MIDDLE CURRENT SURNAME
FIRST
,
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
1. A. FUU NAME
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Ashley Nicole Hendee
MIDDLE CURRENT SURNAME
~
FIRST
11. A. FUll NAME
D..
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)133 68 1346
o SOCIAL SECURITY NUMBER --
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~gcIFY Wappinaer
D. STREET ADDRESS 18 A Chelsea Ridge Dr. ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIllAGE? 0 YES tJ NO
3. A. AGE 24 3B. DATE OF BIRTH 02 / 15 / 1985
MONTH DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 22 3B. DATE OF BIRTH 07 ~5
MONTH DAY
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Silano
(OPTIONAL. SEE REVERSE)1 05-72-1682
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A NY B. Dutchess
(STATE) J.. (COUNTY)
C. CHECK ONE 0 CITY U TOWN 0 VILLAGE
AND W .
SPECIFY ap~lnger
D. STREET ADDRESS 18 A Chelsea RIdge Dr.
ZIP 12b9U
DYES '6 NO
;1"986
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Groundsman
B. TYPE OF INDUSTRY OR BUSINESS VillaQe Of Briarcliff
5. PLACE OF BIRTH North Tarrytown, New York
(CITY, STATE I COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Substitute Teacher
B. TYPE OF INDUSTRY OR BUSINESS Education
15, PLACE OF BIRTH Oneonta, New York.
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Barry Howard Hendee
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Mary Elizabeth Magnan
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
6. FATHER
A. NAME Mark Douglas Silano
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Arlene T atavitto
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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. - YEAR
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) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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 information I provided is true
as to my right to enter into the marnage st te. 0 't '
21. SIGNATURE OF GROOM~ ~ 22. SIGNATURE OF BRIDE~
o 0
o 0
o 0
o 0
al impediment exists
USE CUR
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
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 onl for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY C ERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) 0
{ ~ ~
SEAL SIGNATURE ~ DATE 06/04/2009
I..-- --J MAI!.!IiG "Q,P S AM 009 08 03 2009
-v- LU M in ers Falls, NY 12590 03:02PM 06 05 2
STREET CITYITOWN STATE ZIP
~~:~~~RT':: 'o~O~~~N~ZE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M . AY YEAR 0 IZf RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
YEAR
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED J '
A. STATE NEW YORK B. COUNTY -4ekV,)((A/?
c. LOCATION OF CEREMONY ..J
(CHECK ONE AND SPECIFY)
29. OFFICIANT ./ /'?'7'j /' / -- ~ ~ --.L.
NAME (PRINT) /Y - ~(7JJ?/,.ho If,l . (~^l' N,/_ TITLE 0",:"p"'!:f/z7T'
SIGN~TURE ~...-V/ ~ ~.r- ~~ DATE (")- /9" -t!) ~
MAILING ADDRESS / ~ _
0' '> 5,vc t= ~ /.c.L4. ~ '>6P ~ 4 L'/ 6'-7";-01-
STREET CITY/TOWN ATE ( ZIP
30. WITNESS TO CEREMONY 31. WITNESS TO CEREMONY < \'
NAME (PRINT) .;(i) NAME (PRINT) .\ \.
'.
o CITY OF 0 TOWN OF ~VILLAGE OF
SPECIFY U f ~r '7"
.
SJGNATURE~
DOH-98 (0312006)
SIGNATURE~