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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c; 1 368
~~~I;~~R 124
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFADAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Rnhp.rt Np.I~nn r.nn~tahlp.
MIDDLE CURRENT SURNAME
r
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Lauren Ashle~ Lucchese
MIDDLE CURRENT SURNAME
~
1 . A FULL NAME
11. A. FULL NAME
FIRST
FIRST
B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER 098- 7 6- 2917
2 RESIDENCE A. NY B nlltchp.ss
(STATE) (COUNTY)
C CHECK ONE 0 CITY 0 TOWNol] VILLAGE
~~~CIFY Wappingers Falls
o STREET ADDRESS 14A Franklin Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? rJ YES 0 NO
3. A. AGE ?4 3B. DATE OF BIRTH 01 / 13 /1984
MONTH DAY YEAR
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C SURNAME AFTER MARRIAGE Constable
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER 055-76-4709
12 RESIDENCE ANY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VilLAGE
~~~CIFY Wappinqers Falls
D. STREET ADDRESS 14A Franklin Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE' ~ YES 0 NO
~9 A'985
DAY YEAR
13. A. AGE 23
3B. DATE OF BIRTH
07
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Self Employed
8 TYPE OF INDUSTRY OR BUSINESS Independent Contractor
5. PLACE OF BIRTH Newburgh Ny
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Barry Kenneth Constable
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Susan Joy Knapp
B. COLlNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE -eML-1';NNULMElItT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION Self Employed
B TYPE OF INDUSTRY OR BUSINESS Independent Contractor
15 PLACE OF BIRTH Mount Kisco , Ny
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Robert John Lucchese
. B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Dawne Rose Bruqqer
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
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(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) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
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) (CITY/COUNTY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
C. DATE LAST MARRIAGE ENDED?
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say,
as to my right to enter into the m~.r:r
21. SIGNATURE OF GROOM~L/
1ST
2ND
3RD
o 0
o 0
o 0
o 0
al impediment exists
22. SIGNATURE OF BRIDE~
US
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) Jo n C. Masterson
{ .J 1 TIME MONTH DAY YEAR
SEAL SIGNATURE ~ DATE 09/03/2008
'-.-I MA'~~G~FcfaT~ ush Rd, Wappingers Falls, NY 12590 06:31:~ 09 04 2008
STREET CITYITOWN STATE ZIP
~~iR~':;;'Ri~~~ 'o~O~~N~~E~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS
DATE AND AT THE TIME AND Q... /'
PLACE INDICATED. DO 9 Ill...-oTHER. SPE
DATE
09/03/2008
by New York Domestic
MONTH
YEAR
11
02 2008
28 PLACE WHERE MARRIAGE OCC~ r
A. STATE NEWYORK B COU~~~
C. LOCATION OF CEREMONY """(C~~A' ~
(CHECK ONE AND SPECIFY~'--7~ ----
f\ 9, crry OF OWN OF VILLAGE OF
\.:.Ai.t \ V\
SPECIFY
~\CL+e....,
(~