095
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I duly swear/affirm, dep'0S8 and say, that to the best of my knowledge and belief that the information I provided is trulte and that I declare that no legal i.mpedimenl exists
as to my right to enter into the mama estate. , . /7". .-A\
21. SIGNATURE OF GROOM 22. SIG TURE OF BRIDE~ J ~~ 1AeR~ 1W--
USE CU RE NAME USE CURRENT NAME
23. ~:::f~=~DO~N,.oo~~OJ1~ ci~A~r~~E~ BEFORE ME DATE 08/16/2007
This license authorizes the marriage in New 'York State of authorized by New York Domestic
W Relations Law ~11 to perform marriage ceremonies within New York tate. THIS LICENSE VALID IN NEW YORK STATE ONLY.
UJ 0 If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
Z r-I'-. 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
W { } NAME (PRINT) Jo C. Masterson
o " TIME MONTH YEAR MONTH
::i SEAL SIGNATURE ~ L. DATE 08/16/2007
'-v-I MAI~~G~r8a1~ sh Rd, appinger Falls, NY 12590
STREET ClTYfTOWN STATE ZIP
~~~~~Ri~~J ~~O~~N~Zi~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIM M . Y YEAR O.ft('RELlGIOUS
DATE AND AT THE TIME AND fttr
PLACE INDICATED. . PM to 07 () 90 OTHER, SPECIFY
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FIRST losept)..I~~\AIard Sta~~~t'AME
COUNTY Dutchess
CITYfTOWN Wappinger
~~~~c; 136R .
~~~~J~R 95
1. A. FULL NAME
..
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER OR3-7?-?33?
2. RESIDENCE A. NXTATE) B. 9cb~ess
c. CHECK ONE 0 CITY ol2I TOWN 0 VILLAGE
AND
SPECIFY Hyrlp. P::!rk
D. STREET ADDRESS 66 Windmill Road ZIP 12601
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES!'l NO
3. A. AGE 31 3B. DATE OF BiRTH MjJ{J / 01; / ~75
4. EMPLOYMENT
A. USUAL OCCUPATION r.ivil Fnoinp.p.r
B. TYPE OF INDUSTRY OR BUSINESS Paggi Martin Del Bene
5. PLACE OF BIRTH Sirlnp.v, NAW York
(CITY. STAi'E, COUNTRY IF NOT USA)
6. FATHER
A. NAME nnn::!lrl Rir.h::!rrl St~nk::!v::!gp.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME JoAnn Carosella
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARF,lIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE - -CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY
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
YEAR
29. OFFICIANT ~1V4 \../~~ f'l ~
NAME (PRINT) "IV: ~,.'<J' I'
~2~1~1,U~6~ESS 4- (;,
I '-IoN
CITYfTOWN
I
STATE FILE NUMBER
(rHIS SPACE FOR STA TE USE ONL Y)
"I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
\I::!IUI~~YE M::!rip. W~~~ENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. s~S~1A~~~rt~~C~~s~t::!nl<~v~op.
D. SOCIAL SECURITY NUMBER 083-70-7350
12. RESIDENCE A. f\JV B. nlltr.hp.!=;!=;
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ltl TOWN 0 VILLAGE
~~~CIFY Hyde Park
D. STREET ADDRESS 187 Pinebrook Drive
ZIP 12538
o YES~ NO
;(970
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE ~7 3B. DATE OF BIRTH 03 Aj5
. MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Marketing Manager
B. TYPE OF INDUSTRY OR BUSINESS Laerdal
15. PLACE OF BIRTH Bronx. New York
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME John Vincent Wynn
'B. COUNTRY OF BIRTHU' S A
17. MOTHER
A. MAIDEN NAME Dolores Veronica Genovese
B. COUNlTRY 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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
..- YEAR
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) (CITYICOUNTY. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
YEAR
12:35~~ 08
2007
10
15 2007
17
2B. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY 1)i;"Q.I+f:'S:c;.:
DATE
TITLE II~ e.ev ]) ,Z
ID{'1 to 7
NY
ST),TE
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
At CITY OF ~. TOWN OF 0 VILLAGE OF
SPECIFY iNAi;'~.'IV' $~L 7ffi.\1k~e.
STREJr DC)
LrJ~, ~i'T
30. WITNESS TO CEREMONY
i~ . I .~
NAME (PRINT)
SIGNATURE~
DoH-9B (0312006)
NAME (PRINT)
SIGNATURE~
31. WITNESS TO