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COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~:1368 .
~~~I~J~R48
;:) . Pt. . I: ur .,,1: VV ,un"
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
James Francis Freni
1.41 DOLE CURRENT SURNAME
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Holley Ann Pomarico
MIDDLE CURRENT SURNAME
-.J
11. A. FULL NAME
FIRST
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)073_68_2346
D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. NY B Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY..a TOWN 0 VILLAGE
~~~CIFY Hyde Park
D. STREET ADDRESS 6 Cedar Drive ZIP 12538
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES fJ NO
3. A. AGE 34 3B. DATE OF BiRTH 07 /03 /1974
MONTH DAY YEAR
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE F ren i
(OPTIONAL - SEE REVERSE059_74_631 0
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A.NY BDutchess
(STATE) J... (COUNTY)
c. CHECK ONE Q CITY U TOWN 0 VILLAGE
~~~CIFYHyde Park
D. STREET ADDRESS6 Cedar Drive
ZIP 12035
o YES If] NO
)t970
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE38 3B. DATE OF BIRTH 08 )')8
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Hair Dresser
B. TYPE OF INDUSTRY OR BUSINESS Salon Of New York
15. PLACE OF BIRTH Cold Spring, Ny
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAMEJames Joseph Pomarico
. B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Mama Veronica Smith
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
4. EMPLOYMENT
A. USUAL OCCUPATION TV Production
B. TYPE OF INDUSTRY OR BUSINESS Media
5. PLACE OF BIRTH PouQhkeepsie, Ny
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Dominick J. Freni
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Anne F. Schiavi
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
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT (2) 0 DEATH
/ /
..- YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
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
o 0
o 0
o 0
o 0
al impediment exists
a:'
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~
1ST
2ND
3RD
4TH
I duly swear/affirm, aepose and say, that to th
as to my right to enter Into the mar, ge stat
21. SIGNATURE OF GROOM~
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
my knowledge and belief that the information I provided is true and that I declare that no I
DATE
by New York Domestic
23. SUBSCRIBED AND SWORN To/AFFIR
SIGNATURE OF TOWN OR CITY CLE
This license authorizes the marriage in New York 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.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) John . Masterson .
TIME MONTH YEAR
SEAL SIGNATURE ~ - DATE OS/26/2009
'- .-J MAIWI)lG}.~IPjE,~eS b AM 05
-v-- LU IVI uOI h Rd, Wappingers Falls, NY 12590 02:29PM
STREET CITYITOWN STATE ZIP
~~~R~:RTr~J IO~O'r~N~:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. Y YEAR 0 fIZ} RELIGIOUS
DATE AND AT THE TIME AND AM r
PLACE INDICATED.;l 9 0 OTHER, SPECIFY
MONTH
YEAR
25 2009
07
27
2009
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY /) rf.tv hPCb
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ]l!l TOWN OF 0 VILLAGE OF
SPECIFY ?~UJhlt...fEfS't ~-
29. OFFICIANT
NAME (PRINT)
TITLE ~..()~IA/f"
DATE {I? / Zfi /09
V
STATE ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~
SIGNATURE~
DOH-98 (0312006)