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1 . A. FULL NAME
~ I'" II: ur I~I: YV ,un,,-
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FIRST Frp.deJr~~~ Allyn MaC~~E~~URNAME
(THIS SPACE FOR STATE USE ONLY)
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~c; 1 368 .
~~~I:~~R 33
.J
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
DoroW~J~enita W~~~~ SURNAME
11. A. FULLNAME
FIRST
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Mann
(OPTIONAL - SEE REVERSE)595 92 0556
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE A.NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY~ TOWN 0 VilLAGE
AND W .
SPECIFY apPJnqer
D. STREET ADDRESS 10 Edgehill Dr.
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 090-70-8027-
2. RESIDENCE A. NY B. Dutchp.ss
(STATE) (COUNTY)
C. CHECK ONE olJ CITY 0 TOWN 0 VilLAGE
AND P hk .
SPECIFY oug eepsle
D. STREET ADDRESS 164 Mill St ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? .tJ YES 0 NO
1? / 06 /1985
MONTH OA Y YEAR
ZIP 12590
DYES '6 NO
A990
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 19 3B. DATE OF BIRTH 01 A)4
MONTH OA Y
3. A. AGE 73
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION landscaper
B. TYPE OF INOUSTRY OR BUSINESS Landscaping
5. PLACE OF BIRTH N'lack. New York
(cfrv, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Fp.dp.rick Mann
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Lorianne Bocchino
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION Student
B. TYPE OF INDUSTRY OR BUSINESS Penn Foster
15. PLACE OF BIRTH HillsbrouQh County, Florida
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Terence Hugh Woods
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Nenita Honqya Moslares
B. COUNTRY OF BIRTHPhilippines
1B. NUMBER OF THIS MARRIAGE 1
19. 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 (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH D~ 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
(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) (CITYICOUNTY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and sa I th
as to my right to enter into the
21. SIGNATURE OF GROOM"
o
o
o
o
o
o
o
o
o
o
w
en
z
w
o
::i
USE CU
23. SUBSCRIBEO ANO 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
Relations Law ~11 to periorm 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 urpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRIND Jo n .
TIME MONTH YEAR
SEAL SIGNATURE. TE 05/07/2009
MAILING ADDRES 11 :30AM 05
'-v-/ 20 Middl i ers- Falls NY 12590 PM
STREET ITYIT WN STATE ZIP
~~~R~~Ri~~~ IO~O~~~N~EE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M. DAY YEAR 0 0 RELIGIOUS 1~VIL
DATE AND AT THE TIME ANO
PLACE INDICATED. 9 0 OTHER. SPECIFY
07
06 2009
DATE
by New York Domestic
MONTH
YEAR
08
2009
29. OFFICIANT
NAME (PRINT)
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COU~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF @;'TOWN OF 0 VILLAGE OF
SPECIFY \ Cb1t 'i Vl~J~ r-
NAME (PRIND
SIGNATURE.