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COUNTY Dutchess
CITYrrOWN Wappinger
~~~~c: 1368 '
~5~~J~R 93
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFRDAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
M~~on \I ele7CURRENT SURNAME
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
.JFmnifAr M;:IriA A77;:1rn
MIDDLE CURRENT SURNAME
~
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
0-
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE A 77;:1 rn- \I AIA7
(OPTIONAL. SEE REVERSE)056 56 9118
D. SOCIAL SECURITY NUMBER ___ - __ - _ _ _ _
12. RESIDENCE A. NY B. nlltr.hA~~
(STATE) (COUNTY)
C. CHECK ONE 0 CITY iZI TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D. STREET ADDRESS44 All Angels Hill Rd.
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 11 A- 7 4-3615
2. RESIDENCE A. NYsTATE) B. qcYS~ASS
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W .
SPECIFY ;:IpplngAr
D. STREET ADDRESS 44 All Angels Hill Rd. ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VIllAGE? 0 YES 'tJ NO
3. A. AGE 25 3B. DATE OF BiRTH MO~ / z.~ / ~~~1
4. EMPLOYMENT
A. USUAL OCCUPATION TAr.hnir.;:I1 ~lIppnrt RAp
B. TYPE OF INDUSTRY OR BUSINESS Financial
5. PLACE OF BIRTH Manhattan, NY
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME I lIi~ Tnm;:l~ VAlP.7
B, COUNTRY OF BIRTH Puerto Rico
14. EI.!PLOYMENT
A. USUAL OCCUPATION Account Manager
B. TYPE OF INDUSTRY OR BUSINESS Health Care
15. PLACE OF BIRTH North Tarrytown. NY
(CfTY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Russell George Azzaro
. B. COUNTRY OF BIRTHU S A
ZIP 12590
DYES tJ NO
;(973
YEAR
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VIllAGE?
13. A. AGE 34 3B. DATE OF BIRTH 05 A9
MONTH DAY
17. MOTHER
A. MAIDEN NAME Marie Anne Minardi
B. COUNTRY OF BIRTHltaly
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) 1!1 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / / C. DATE LAST MARRIAGE ENDED? 03 / 21 /2001
MONTH DAY YEAR MONTH DAY, ". - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? i!f YES 0 NO
..
10, IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREV/OUSL Y DIVORCED OR ANNULLED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEAR) (CfTYICOUNTY. STATElCOUNTRY. IF NOT USA) SELF SPOUSE (MONTH. DAY, YEAR) (CITYICOUNTY. STATEICOUNTRY. IF NOT USA) SELF SPOUSE
o 0 1ST 03/21/2001 Danbury, Connecticut ~ 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
y that to ~e best of my knowledge and belief that the information I provided is truvnd t~at I de"lara tha' "", lo~'" 1Il'!.I"Ullnem eXI
22. SIGNATURE OF BRIDE ~\5' 0... 1Y\Clt.. J.. 0 G3)CJ..>\T'
USE CU ENT " us'!: CURRENT NAME
~~ D~OW1~20~
7. MOTHER
A. MAIDEN NAME Luz Nereida Malave
B. COUNTRY OF BIRTH Puerto Rico
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
DEATH
o
1ST
2ND
3RD
4TH
I duly swear/affirm, dep.ose and
as to my right to enter Into the
21. SIGNATURE OF GROOM~ '"
23. SUBSCRIBED AND SWORN T
SIGNATURE OF TOWN OR C
by New York Domestic
This license authorizes the te of the ride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies withi ew York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for the pu se of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
C. Mas er on
w
C/)
Z ,-A-..
W { } NAME (PRINT)
~ SEAL SIGNATURE ~
'-v-I MA~5GlCWcfa~ appinger Falls, NY 12590
STREET CfTYlTOWN STATE ZIP
~~~R~~RT~~J 'o~~~NIf:~ 26. SOLEMNIZATION OCCURRED
SONS NAMED ABOVE ON THE TIME MO. AY. YEAR
DATE AND AT THE TIME AND /_ AM D
PLACE INDICATED. '0 1)
-\6u.s~
YEAR
YEAR
MONTH
DATE
08/15/2007
TIME
MONTH
06:31 ~~ 08
2007
10
14 2007
16
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~
C. LOCATION OF CEREMONY
(CHECK ONE AN~ECIFY)
o CITY OF []/,-OWN OF 0 VilLAGE OF
SPECIFY1lhl (,f{lO~
27.TYP~FCEREMONY
o MELIGIOUS 1 0 CIVil
9 0 OTHER. SPECIFY
~L.% f~~
DATE ~ ~ '()?-
I /
STATE
i'
DIVORCE (DISSOLUTION OF
MARRIAG'El,AGREEMENT
JD-FM-172 ~Ne'Iv 8-08 '
C.G.S. 5 <48b-51
JUDICIAL DISTRICT OF
Danbury
PLAlNl1FPS NAME (Last. First, Middle Inl/Jal)
Jay, Jeremy, S.
STATE OF CONNECTICUT
SUPERIOR COURT
~
I llIIIlllllO WI DlII.11
. AT (Town)
I DOCKET NO
FA 00 0340741
DEFENDANTS NAME (Last, First, Middle Inl/Jal)
Jay, Jennifer, A.
The wife and husband agree that:
1. Our marriage has broken down irretrievably. (No-fault divorce.)
2. As to custody of our children:
Legal Custody:
N/A
Primary Residence:
N/A
3. As to visitation with our children:
N/A
Holiday and school vacation visits:
N/A
4. As to child support:
(fl
~ Co
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005> ;0 :;;;: 0
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This amount must agree with the Child Support and Arrearage Guidelines (available at Clerk's 8m~) unl~s yo~~t
one of the deviation criteria listed in the Guidelines. 0 Agrees 0 Does not agree (giv~re~n fQ,!'rlieviatiaA)
-~ <::) w
N/A
5. As to health insurance and unreimbursed medical costs:
Each party will be responsible for their own health insurance.
(Continued...)
t: I
I O/',. r' 0
O~' 'J
t" ..
As to. al,imal'io/:
Parties waived alimany fram eachather.
7. As to. divisian af praperty: The fallawing property issues have ar will be addressed as fallaws;
1.Each party will be respansib+e far all payments, insurance, damages, and mileage
expenses arising fram the lease af the fallawing vehicles. Jennifer 2000 Jeep
Cherakee Spart. Jeremy 2000 Nissan Altima.
2.First Unian bank accaunts clased and divided equally.
3.Each party shall keep their awn 401K and waive any claims to. the athers retirement fund.
4.Stack partfalia was saId and divided equallyS AT&T 100 shares, AT&T Wireless 400 shares.
ECNC transferred to. Jennifer, 100 shares.
5.Jennifer shall keep all furniture in the apartment.
6.Jennifer entitled to. security depasit fram 3122 Avalan Valley Dr.
AII~praperty has been
re~i"i^,\ -!D.~ :rsr
previausly divided by bath parties to. their mutual satisfactian.
)() i 3"sr '
I(\CVrf~Jl~r;cr to 91tlDO, hut" +.,
~ l'\bf 'fI.1.cfe. ~.('r\ the Pltl.:lliJ\ I~ (.s/~
8. As to. divisian af debts: The fallawing debt issues have ar will be add essed as fallaws;
I.E&ch individual will pay 50% af the fallawing dactar bills directly to. each dactar
Dr. Starke $230, Dr. Weiser $300, Dr. Navella $680, Dr. Salzman $200, Dr. Lassaw $252.
Any bills incurred after September 1, 2000 is the sale respansibility af that individual.
2.Jeremy will send a check to. Jennifer up an rec~pt af the cleaning bill for 3122 Avalan
Valley Dr. The check will be the amount of the cleaning bill.
3.Marie Azzara will be reimbursed a laan af $4000 ,from praceeds of tJe S~k sale.
4.Jennifer to. receive $3564 fram proceeds af stock sale.~ ::#:7.f '\{' r...<;;,~'
~5.Jeremy to. pay $7765.50 to. MBNA America credit card to satisfy his al~o cr~dif card debt.
6.Jeremy's name will be taken aff the MBNA America credit card.
7.Jeremy paid $1129.11 to. Citibank Aadvantagecredit card to satisfy his half of credit card
debt.
~ 5. U~bl\ s~hsfoc\-;(lJ'\ ofp':\\II"l-tV\+oVlot fees at- 415~.oo. ~()4
9. As to. change of wife's name: . p _ _
Je1\'/\Jfer ~Arie. oJo.J )$,) .
Wife's maiden name af1Azzara will be restored.
:f j 'S"'
10. Other
STATE OF 'CONNECTICUT
. ~SUPERIOR COURT
:.JUDICIAL DISTRICT OF
DAN~.'.. ,'r
~JAN 2 4 2002 '
We certify that the above statements are our agreement.
CERTIFIED Cr;.?y
c:~ tL AF I:: ., Q
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