177
21. SIGNATURE OF GROOM~.
'.I," USE CU
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New ork State of the bride and groom named above by any pe on authorized
Relations Law !l11 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
+
(")w
O~
(O~
N
...--
>-
>-
Z
W
UJ
W
III
o
...J
::>
o
I
UJ
Z
o
i=
~
>-
UJ
a
w
a:
w
~
a:
a:
<
:;
u.
o
w
~
()
u:
i=
a:
w
()
w
a:
w
~
l-
S;
c(
c
wi!
"'LL
;Jc(
UJ
UJ
w
a:
o
o
<
~
13
w
0-
UJ
a:'
w
III
::;
=>
Z
o
Z
<
t;j
w
a:
~
+
~~~ W
>-a:i= I-
~~tl ..,
>-wz .....
3c3~ 0
~~g i!
~~~ ~
[toUJ W
~~~ 0
I!!~",
ol'5
Z:J~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
John Paul Faour
MIDDLE CURRENT SURNAME
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
e best of my knowledge and belief that the information I provided is
DATE 11/26/200
F I NY 12590
STATE ZIP
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
COUNTY Dutchess
CITYITOWN Wappinger
~~~:~c; 1368
~5~1:;~R 1 77
1. A. FULL NAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
O. SOCIAL SECURITY NUMBER 114-72-4524
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY olJ TOWN 0 VILLAGE
ANO P hk .
SPECIFY oug eepsle
D. STREET ADDRESS 27 Partners Trace ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES'6 NO
09 /28 /1982
MONTH DAY YEAR
3. A. AGE ?R
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Stl Jrlp.nt
B. TYPE OF INDUSTRY OR BUSINESS Culinary Institute Of
5. PLACE OF BIRTH Pouahkeeosie, Ny
(CITY, S'i'ATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Rnhp.rt .In~p.rh Faour
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Cherie Rose Ellis
B. COUNTRY OF BIRTH USA
6. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
n 0
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
DEATH
o
(2) 0 DEATH
(3) 0 ANNULMENT
/ /
YEAR
MONTH DAY
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
W
en
z
W
o
::i
~
{ SEAL}
'-v-'
NAME (PRINn
SIGNATURE ~
MAILING ADDRESS
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
ITYfT N
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
A
M
i 2 a;). D2cQ}
12.:00
~~~l~~~~~T :JOHn c.. tv\A<;78<so/)
SIGNATURE ~ gfl. C1t~
MAILING ADDRESS .
~(~ M 1.11>1 E{SvStf a: wA(?P;J()&ei'-S
STREET I CITYITOWN
30. WITNESS TO CEREMONY
TITLE
DATE
?4n '>
NAME (PRINT)
-r
SIGNATURE~
DOH-98 (03/2006)
0114.11:. r"'1L.J:. nUMDcn
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Gloria Elena Pocaterra
MIDDLE CURRENT SURNAME
.-J
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Pocaterra-faour
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANY
(STATE)
C. CHECK ONE 0 CITY ~ TOWN 0
~~~CIFY PouQhkeepsie
D. STREET ADDRESs27 Partners Trace
B Dutchess
(COUNTY)
VILLAGE
ZIP 12603
DYES '6 NO
)1'981
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 27 3B. DATE OF BIRTH 04 /27
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Unemploved
B. TYPE OF INDUSTRY OR BUSINESS Unemployed
15. PLACE OF BIRTH Caracas, Venezuela
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A_ NAME Edgar Humberto Pocaterra
'8- COUNTRY OF BIRTHVenezuela
17. MOTHER
A. MAIDEN NAME Gloria Bellot
B_ COUNTRY OF BIRTH Venezuela
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 10 / 02 / 2008
MONTH DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~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
10/02/2008 Delrav Beach, Florida 0 ~
o 0
o 0
o 0
no legal impediment exists
DEATH
o
22. SIGNATURE OF BRI
11/26/2008
DATE
by New York Domestic
TIME
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
YEAR
MONTH
DAY
YEAR
11 :59AM
PM
2008
01
25 2009
11
27
28. PLACE WHERE MARRIAGE OCCURRED
1 Il2l"CIVIL
A. STATE NEW YORK B. COUNTY b l/1l.:J..1e s 5
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF [,;('lOWN OF 0 VILLAGE OF
SPECIFY {,;..i A-fP r t1J6ffl--
IY1 fWJ).,r Af ~ cJ+- I c.~ L
p--(Oz./ZOC)fj
I dS-"/"
ZIP
IVt
STA E
" w,,,,'" ro C,"'"ON' . . ~.
:::::::: ~r~?Z