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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
In~pr~lo~LtP\lpn 1::lr.bJU~~NT'lcRNAME
This license authorizes the marriage in New York State of the bride and groom named above by any person 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
{ } NAME (PRINT) John .
TIME MONTH YEAR
SEAL SIGNATURE ~ / 7/2008
MAILING ADDRESS AM
'-..,-I 20 Middleb NY 12590 05:39 PM 08
STREET TATE ZIP
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
~~~SM~~~~~EAB~V;H~N P.f~E 0 0 RELIGIOUS 1 0 CIVIL.t
DATE AND AT THE TIME AND ~ II '5+
PLACE INDICATED. - 0'0 9 ['j[ OTHER, SPECIFY +hJ rna.n\
COUNTY [)utchess
CITYfTOWN Wappinger
2~~:~; 1 368
~~~~~~R 11 7
1. A. FULL NAME
FIRST
B. BIRTH NAME. IF OIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER OR7 -R8-8931
2 RESIDENCE A NY B nlltr.hp~~
(STATE) (COUNTY)
C CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W .
SPECIFY r1pplnger
D STRm ADDRESS 16 Carnaby Street. Apt. A ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES..o NO
1 n /?4 /1 q7q
MONTH OAY YEAR
3. A AGE28
3B. DATE OF BIRTH
~
:>
4. EMPLOYMENT
A. USUAL OCCUPATION Fiplrl M::ln::lopr
B TYPE OF INDUSTRY OR BUSINESS Automotive
5. PLACE OF BIRTH Yonken:; NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME In~prh ~tp\lpn .I::lr.nhy
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Krlren Joan Locurto
8. 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
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
MONTH OAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF OECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
w
UJ
Z
W
o
:i
+
TITLE
SIGNATURE~
rv",u no fn-:J I")"n~\
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Amrlndrl M~r~ Mrllrltras
MIODLE CURRENT SURNAME
.-J
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C SURNAME AFTER MARRIAGE .I::lr.nhy
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER 137-84-8518
12 RESIDENCE ANY BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY otJ TOWN 0 VILLAGE
AND W .
SPECIFY applnger
o STREET ADDRESS 16 Carnabv Street. Apt. A
ZIP 12590
o YES'6 NO
;(981
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE/R 3B. DATE OF BIRTH 10 A 4
MONTH OA Y
14 EMPLOYMENT
A. USUAL OCCUPATION Medical Biller
B TYPE OF INDUSTRY OR BUSINESS Medicai
15 PLACE OF BIRTH Westwood. New Jersey
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A NAME John James Malatras
'B COUNTRY OF BIRTJJ S A
17. MOTHER
A. MAIDEN NAME Mary Andrews
B. COUNTRY OF BIRTJJ S A
1B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER 'OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / (
MONTH DAY 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
o 1ST
o 2ND
o 3RD
o 4TH
lief that the information I provided is true
o
o
o
DATE 08/27/2008
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIONIGHT ON:
MONTH
DAY
YEAR
28
200810
26 2008
28. PLACE WHERE MARRIAGE OCCURF"''l
DATE
1ie:'l e-r .e:n d
~-~-D<O
A. STATE NEW YORK B. COUNI,.. - .
~neSS
C.ou~
(CHECK ONE AND SPECIFY) . .. I
CITY OF~ TOWN OF 0 VILLAGE OF
"",,, INllf'P'r ~,'5
('1'0 W~o\m-e-re d.
C. LOCATION OF CEREMONY
NAME (PRINT)
SIGNATURE~
\,..