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COUNTY Dutchess
CITYn-OWN Wappinqer
~~~:kc: 1368
~G~I;~~R 48
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseoh William Villani
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
BrandJID~~anna Fr~~j~g SURNAME
~
1 , A FULL NAME
11. A FULL NAME
FIRST
FIRST
Q.
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Villani
(OPTIONAL - SEE REVERSE)576 23-7883
D. SOCIAL SECURITY NUMBER -
12 RESIDENCE ANY B Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinqer
D. STREET ADDREss21 B Carnaby 81.
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 065-72-8387
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY olJ TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D STREET ADDRESS 21 B Carnabv 81. ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES'6 NO
07 /23 /1982
MONTH DAY YEAR
ZIP 12590
DYES tJ NO
;(984
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 24 3B. DATE OF BIRTH 01 /1' 1
MONTH DAY
3. A. AGE ?~
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Auto Body Technician
B. TYPE OF INDUSTRY OR BUSINESS Automotive
5. PLACE OF BIRTH Beacon, NY
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Alfn:~rl S;::!lv;::!tore Villani
B. COUNTRY OF BIRTH U 8 A
7. MOTHER
A. MAIDEN NAME Pamela Corrigan
B. COUNTRY OF BIRTH U 8 A
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 Medical Biller
B. TYPE OF INDUSTRY OR BUSINESS Medical
15. PLACE OF BIRTH Wailuki, HI
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Keith Richard Fraking
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A MAIDEN NAME Karen Marie Cartwriqht
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) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE 13) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / (.
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(31 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
~
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
o
o
1ST
2ND
3RD
o 0
o 0
o 0
o 0
t no legal impediment exists
DATE
05/07/2008
by New York Domestic
~
{ SEAL }
'-v-I
TIME
MONTH
YEAR MONTH
YEAR
AM
06:38PM 05
08 2008 07 06 2008
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 0 CIVIL 1'\ .J. A^ " 55'
A. STATE NEW YORK B. COUN~ V JVW
C. LOCATION OF CEREMONY( t:'CU+ hS. h k'u-
(CHECK ONE AND SPECIF1Q.. \ { /"
a~h;'OF!{;l~OFL~ 'l2ft5?~
SPr'CIFY "'V -I
ZIP ~tiJ.. ;Juncfibr,/ ^-!J/2sF.
1. WITNESS TO CEREMONY
- ,.( - .,J
NAME (PRINT)
SIGNATURE~
DOH-98 (03/2006)
SIGNATURE~