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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c; 1368 '
~~~I~:~R 122
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFADAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
.Inhn AnrlrAw W;::)ttAr~nn
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Keri Ann Farino
MIDDLE CURRENT SURNAME
1, A, FUUL NAME
11, A, FULL NAME
FIRST
FIRST
Q.
N
B, BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C, SURNAME AFTER MARRIAGE W;::)ttAr~on
(OPTIONAL - SEE REVERSE)130 72-4392
0, SOCIAL SECURITY NUMBER -
12. RESIDENCE A NY B. Ulster
(STATE) (COUNTY)
C. CHECK ONE D CITY otJ TOWN D VILLAGE
~~~CIFY Lloyd
D, STREET ADDRES~40 Tuckers Corners
B, BIRTH NAME, IF DIFFERENT
C, SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D, SOCIAL SECURITY NUMBER 112-70-6979 '
2. RESIDENCE A NY B, nllt~hA~!=:
(STATE) (COUNTY)
C, CHECK ONE D CITY olJ TOWN D VILLAGE
~~~CIFY Hyde Park
D, STREET ADDRESS 4 Golden Way ZIP 12580
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIULAGE? D YES ~ NO
3, A. AGE ~~ 3B. DATE OF BiRTH nq / 1 n /1 q7?
MONTH DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIULAGE?
13, A, AGE ?fi 3B. DATE OF BIRTH 03 A 0
MONTH DAY
ZIP 12528
D YES'tJ NO
;(982
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Poli~A Offi~Ar
B, TYPE OF INDUSTRY OR BUSINESS Law Enforcement
5. PLACE OF BIRTH Carmel. New Yark
(CITY, STATE I COUNTRY IF NOT USA) .
6. FATHER
A, NAME John R Watterson
B. COUNTRY OF BIRTH U S A
7. MOTHER
A, MAIDEN NAME Toni Orlando
B. COUNTRY OF BIRTH U S A
8. NUMBER OF THIS MARF,lIAGE 1
9, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVILANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION N ursery School Teacher
B. TYPE OF INDUSTRY OR BUSINESS Education
15. PLACE OF BIRTH Newburgh. New Yark
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Thomas Joseph Farino
'B. COUNTRY OF BIRTJJ S A
17, MOTHER
A. MAIDEN NAME Harriett De Santis
B. COUNTRY OF BIRTHU 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
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
B, HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
0, 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) (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
(3) D ANNULMENT
/ /
(2) D DEATH
(3) D ANNULMENT (2) D 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) (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
rr.'
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1ST
2ND
3RD
D
D
D
D D
D D
D D
D D
iment exists
1ST
2ND
3RD
23, SUBSCRIBED AND SWORN
SIGNATURE OF TOWN OR CLERK ~
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 onl for the purpose of a second or subsequent ceremony,
~ 24, TOWN OR CITY CLERK 25. A SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) John .
{ ~ ~ ~
SEAL SIGNATURE~ DATE 09/17/2007
'-..t-I MA~I~GlCffcfdf~bus ers Falls, NY 12590 02: 15 ~~ 09 18 2007
STREET CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26, SOLEMNIZATION OCCURRED 27;:TYP OF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE TIME MO, DAY YEAR 0 RELIGIOUS 1 D CIVIL
DATE AND AT THE TIME AND . / . /
PLACE INDICATED. ,()(J PM 0;07/.2()O 7 9 D OTHER, SPECIFY
~~~lr~~~"e(;y, n>t€. Y!:vu:~) F. ~Rc,Et.L;.' TITLE ~co~
SIGNATURE~ ~s-::Pr ~o DATE /O/c;7/..200 7
MAILING ADDRESS .r l ')to>"., fJ YJ; ~ (( ,-.[ )..,
7/ G"e.......eJ,rr, ~~. ,€~>r. 73C/1 ~".e/~()/ Nt"vv 'Yo.cl /Z,J-Yl
STREET CITY/TOWN stATE
30. WITNESS T
09/17/2007
DATE
by New York Domestic
MONTH
YEAR
11
16 2007
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B, COUNTY tI,6 ;';:(2..
C.
NAME (PRINT)
SIGNATURE~
DOH-98 (0312006)
NAME (PRINT)
SIGNATURE~