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COUNTY Dutchess
CITYfTOWN Wappinger
~~~~~c~ 1368
~~~I~~~R 56
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Keith Francis Gannon
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Brand~ID~~nee Armc~~~~fsURNAME
~
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Gannon
(OPTIONAL. SEE REVERSE) 388
D SOCIAL SECURITY NUMBER 577-98- 0
12 RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C CHECK ONE D CITY D TOWN ~ VILLAGE
~~~CIFY Wappingers Falls
D STREETADDRESS 1548 Route 9 Apt. 7b
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 050-72-6504
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C CHECK ONE D CITY D TOWNI(] VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDRESS 1548 Route 9 Apt. 7B ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES D NO
Of) / /1 /197f)
MONTH DAY YEAR
ZIP 12590
tJ
E. is RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 29 38. DATE OF BIRTH 08 /'11
MONTH DAY
YES D NO
/1'978
YEAR
3. A. AGE 31
38. DATE OF BIRTH
...
:>
<C
4. EMPLOYMENT
A. USUAL OCCUPATION Pnlice Officer
B. TYPE OF INDUSTRY OR BUSINESS Law Enforcement
5. PLACE OF BIRTH Bronx, New York
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME nnn~lrl Anthnny ~~nnnn
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Linda Joanne Liddell
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS. MARRIAGES WHICH ,ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
8. TYPE OF INDUSTRY OR BUSINESS Education
15 PLACE OF BIRTH Prince George County, Maryland
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Gary Henry Armacida
. B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Dale Anne Carrozza
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
(2) D DEATH
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE (3) D ANNULMENT (2) D DEATH
c. DATE LAST MARRIAGE ENDED? / (.
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D NO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROViDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEAR) (CITY/COUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
(3) D ANNULMENT
/ /
C. DATE LAST MARRIAGE ENDED?
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, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
1ST D D 1ST
2ND D D 2ND
3RD D D 3RD
~ D D ~
I duly swear/affirm, depose and say, that to the best of my knowledge and belief that the information I provided'
as to my right to enter ~nto the nag;:!.tate,
21, SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~
D
D
D
This license authorizes the marriage in New York 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.
D 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
by New York Domestic
~
{ SEAL }
'-v-I
NAME (PRINT)
SIGNATURE ~
MAILING ADDRESS
YEAR
MONTH
YEAR
TIME
MONTH
OS/28/2008
12590
ZIP
AM
02:44PM
29
2008
07
27 2008
05
ITY
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
AM I
3,00 PM 7 -~~ Og
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
28. PLACE WHERE MARRIAGE OCCURRED
1 D CIVIL
A. STATE NEW YORK B. COUNTYc.D UTt 1+ C?<;. ~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF D TOWN OF ~ VILLAGE OF
29. OFFICIANT G N:::&:
NAME (PRINT) _ _
SIGNATURE ~ 1
MAILING ADDRESS -
II tLJJ'llf? N QT ~) APPfNCt6tZ{
STREET CITYfTOWN
30. WITNESS TO CEREMONY
"IV ,': (
tMl~
TITLE PAROC.I AI- V, L:./-=I R
DATE 7 ! ~ C;:/OrQ
N Y I~ 5: q 0
STATE ZIP
31. WITNESS TO FEREMOIIIY 1\._
NAME (PRINT) ~(lm~ 'H'f rYIQ CJ ~
SIGNATURE~ ~\L. fJ.;..J~ ck:c.-
F.tk..L.i
SPECIFYJJJ A-PV( NOGK~
NAME (PRINT)
SIGNATURE~
DOH-98 103/2006\