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:s I A II:. UI- NI:.W YOHK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Richard Aldo Valzania
MIDDLE CURRENT SURNAME
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 m ,g t ,e~A
21. SIGNATURE OF GROOM~'e;v- 22. SIGNATURE OF BRIDE~
U
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New rk 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) J C, Mast
TIME MONTH YEAR
SEAL SIGNATURE ~ DATE 10/30/200
~~~~ ~
'-v-' 20 Midale sh Rd, Wappinqers Falls, NY 12590 02: 11PM 10
STREET CITYITOWN STATE ZIP
~~~R~~~RT~~~ IO~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR O~RELlGIOUS
DATE AND AT THE TIME AND AM
PLACE INDICATED.::( 90 OTHER, SPECIFY
oJ
TITLE UrTtt>L I c::.
DATE-1LJ z;s fag
vJELL J/,f,,.;,-7(,,~ A1 '
STATE
COUNTY Dutchess
CITYITOWN Wappinger
~~~:~RT 1368
~G~I;~~R 168
1. A FULL NAME
FIRST
a.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)075_36_9112
o SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY '!"J TOWN 0 VILLAGE
~~~CIFY Wappinqer
D. STREET ADDRESS 56 Scott Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES'6 NO
01 /07 /1944
MONTH DAY YEAR
3. A AGE 64
3B. DATE OF BIRTH
4. EMPLOYMENT
A USUAL OCCUPATION Forklift Operation
B. TYPE OF INDUSTRY OR BUSINESS Beverage Distribution
5. PLACE OF BIRTH Bronx, Ny
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A NAME Aldo Valzania
B. COUNTRY OF BIRTH Italy
7. MOTHER
A MAIDEN NAME Lydia Wanderlinqh
B. COUNTRY OF BIRTH Italy
8. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
1
(2) ~ DEATH
1987 '
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 11 / 07 /
MONTH .PAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES erNO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CrrY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
YEAR
w
en
z
w
o
:i
29. OFFICIANT
NAME (PRINT)
NAME (PRINT)
SIGNATURE~
DOH-98 (03/2006)
(TH/S SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Claudia Barbini
.J
11. A. FULL NAME
CURRENT SURNAME
FIRST MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Rossi
C. SURNAME AFTER MARRIAGE Barbini-Valzania
(OPTIONAL - SEE REVERSE) 129-46-6882
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. NY B Dutchess
(STATE) J. (COUNTY)
C. CHECK ONE Q CITY U TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 56 Scott Drive
Z 12b8U
IP
DYES '6 NO
)f949
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 59 3B. DATE OF BIRTH 06 ~O
MONTH DAY
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Assistant Branch Manager
B. TYPE OF INDUSTRY OR BUSINESS Banking
15. PLACE OF BIRTH Bedonia, Italy
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Rinaldo Rossi
'B. COUNTRY OF BIRTH1ta1y
17. MOTHER
A. MAIDEN NAME Liberata Milani
B. COUNTRY OF BIRTH Italy
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
1
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) ~ DEATH
06 / 29 / 1987
MONTH JAY' . ~ YEAR
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
C. DATE LAST MARRIAGE ENDED?
o 0
o 0
o 0
o 0
'mpediment exists
DATE 10/30/2008
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
DAY
YEAR
31
2008
29 2008
12
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY D~rc HeSS
\JESt
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY ~sT FiSJfJ(lLt...
NAME (PRINT)
SIGNATURE~