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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c; 1368 '
~5~~~~R 98
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Ant~f6~l' .1;::)mA~ ~wRQ~isURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
- I
~
Lo
SUPPLEMENTAL FILE
FROM THE BRIDE
Brianne Ashley Bo~er
MIDDLE C RENT SURNAME
1 . A. FUll NAME
11. A. FUll NAME
FIRST
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 096 74 3517
D. SOCIAL SECURITY NUMBER ___ - __ - -- - -
2. RESIDENCE A. NY B. nlltchA~~
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W '
SPECIFY applnger
D. STREET ADDRESS 245 Ketchamtown Road ZIP 12590
E. IS RESIDENCE WITHIN UMrrs OF CITY OR INCORPORATED VILlAGE? 0 YES ~ NO
3. A. AGE 1 q 3B. DATE OF BIRTH OR / 1!i / 19RB
MONTH DAY YEAR
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE NAnni
(OPTIONAL - SEE REVERSE)085 76 6798
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE A. NY B. Dutchess
(STAT!,) (COUNTY)
C. CHECK ONE ~ CITY 0 TOWN 0 VILLAGE
~~~CIFY Beacon
D. f1TREET ADDRESs4A South Steuben Court ZIP 12508
E. IS RESIDENCE WITHIN UMrrs OF CITY OR INCORPORATED VILlAGE? tJ YES 0 NO
/17 /1'984
DAY YEAR
13. A. AGE ?~
3B. DATE OF BIRTH
05
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Co;::)~t Guard
B. TYPE OF INDUSTRY OR BUSINESS Military
5. PLACE OF BIRTH Pouohkeepsie. New York
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME James Fulvia Nenni
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Jacqueline Ann Scarafino
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 Manager
B. TYPE OF INDUSTRY OR BUSINESS Pet
15. PLACE OF BIRTH Pouqhkeepsie. New York
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Richard Boyer
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Debra Holsapple
B. COUNTRY OF BIRTH USA
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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. -, - YEAR
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
;O.-IF-PREVIOUSI:YDIVORCED OR-ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
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
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I duly swear/affirm, depose and say, that to the best of my knowledge and belief that the information I provided is t
as to my right to enter into the mamage state. ~
21. SIGNATURE OF GROOM~ 22. SIGNATURE OF BRIDE~
o 0
o 0
o 0
o 0
o legal impediment exists
DATE
08/21/2007
W
tn
Z
W
(,)
::i
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFO
SIGNATURE OF TOWN OR CITY CUERK ~
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.
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) J C. Mas erson
{ ~ ~ ~
SEAL SIGNATURE~' DATE 08/21/2007
I.- .-J MAll-I~ ;'~IDij~S AM 08 22 2007
-v- LU IVIOOl appinger Falls, NY 12590 02:12PM
STREET CITYITOWN STATE ZIP
~~~~~RT.i:'~~ IO~O~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~IL
SONS NAMED ABOVE ON THE TIME M. DAY YEAR 0 0 RELIGIOUS
DATE AND AT THE TIME AND ()
PLACE INDICATED. _ M 9 0 OTHER, SPECIFY
10
20 2007
by New York Domestic
MONTH
YEAR
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~Ll~JU~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WN OF 0 VILLAGE OF
SPECIFYJ-J "ff' ~ e ('