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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c: 1 368
~~~I~~~R 58
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
[)(;I\/i~ID~L~mp.tt Kil~~g,~~URNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
FIRST
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
r1anielle Eli7:aheth DeStefano
FIRST MIDDLE CURRENT SURNAME
1. A FULL NAME
11. A. FULL NAME
"-
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT I ::l \I::l r.r.:::J
C SURNAME AFTER MARRIAGE np.~tp.f:::Jnn-KilkAnny
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER 085-70-5574
12. RESIDENCE ANY B. D1Jtchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~ClFyWappinQers Falls
D. STREET ADDREss25A Fulton Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? tJ YES 0 NO
A'l7 /1'971
DAY YEAR
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
D. SOCIAL SECURITY NUMBER 087-68-4619
2. RESIDENCE A. NY B. nlltr.hp.!::!::
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWNo,l] VILLAGE
~~~CIFY WarringArs Falls
D STREET ADDRESS 25A Fulton Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? tl YES 0 NO
3. A AGE 35 3B DATE OF BIRTH nR /?n / 1972
MO'mfi rJJi.'1 YEAR
38. DATE OF BIRTH
04
MONTH
13. A. AGE ~7
4. EMPLOYMENT
A USUAL OCCUPATION ph Imber/~tp.:::Jmfittp.r
B. TYPE OF INDUSTRY OR BUSINESS Cnn~trLJctinn
5. PLACE OF BIRTH Mt Ki!::r.n Np.w Y nrk
(CITY, STATE / CdUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION HnmAmaker
B. TYPE OF INDUSTRY OR BUSINESS Homemaker
15. PLACE OF BIRTH Mount Vernon, New York
(CITY, ST ATE / COUNTRY IF NOT USA)
6. FATHER
16. FATHER
A. NAME VincAnt I a\lacca
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Katherine Sky
B. COUNTRY OF BIRTHU S A
1B. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH
1 0 0
8. HOW DID LAST MARRIAGE END? (3) I!I'DlVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? Of) / ?7 / 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
1ST OS/27/2008 Poughkeepsie, NY
2ND
3RD
4TH
A NAME Timothy RobE'rt KHlcenny
B. COUNTRY OF BIRTH I J ~ A
7. MOTHER
A MAIDEN NAME Mary Thp.rp.!=:a T nhias
B. COUNTRY OF BIRTH I J ~ A
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
n
(2) 0 DEATH
o
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
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
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say t
as to my right to enler into
21. SIGNATURE OF GROO
o
o
o
o
o
o
ation I provided is
ofm
a
22. SIGNATURE 0 RIDE~
23. SUBSCRIBED AND SWORN TO/AF
SIGNATURE OF TOWN OR CITY LE
This license authorizes th ' marriage in New YDrk State of the bride and groom named above by any person authorized
Relations Law ~lltD perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is tD be used only for the purpose of a secDnd or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME(PRINT) .In~~ ~
{SEAL SIGNATURE ~ 'J- ~ DATE nRIO~/?nOR TIME MONTH YEAR
MAILING ADDRESS AM
'-v-I STR?R Mirlrllp.hll!::h Rrl, War~h~~J!=: Falls'sT~rr 1259~p 03:29PM 06 04 2008
~~~R~~~Ri~~~ IO~O~~~N~~E~ 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 '~ELIGIOUS
DATE AND AT THE TIME AND , AM ~il
PLACE INDICATED. , t() P .::JI/(I ~ 9 0 OTHER, SPECIFY
MONTH
YEAR
08
02 2008
10 CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED ~
A. STATE NEW YORK B. COUNTY WI/J 7(
29. OFFICIANT
NAME (PRINT)
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
SIGNATURE ~
MAILING ADDRESS