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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Steven Michael Vollaro
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYrrOWN WappinQer
~~J:~: 1368 '
~5~1:~~R 65
1. A. FULL NAME
FIRST
11.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 088 66 4503
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C, CHECK ONE 0 CITY t'i TOWN 0 VILLAGE
~~~CIFY Pouahkeepsie
D. STREET ADDRESS 3 Vaeth Road ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES tJ NO
3. A. AGE 27 3B. DATE OF BiRTH 12 / 17 / 1979
MONlli DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Contractor
B. TYPE OF INDUSTRY OR BUSINESS V & C Builders
5. PLACE OF BIRTH Queens, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Joseph Anthony Vollaro
B, COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Cherie Ann Poit
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
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
1ST
2ND
3RD
4TH'
I duly swear/affirm, dep'0S8 an
as to my right to enter into the
21. SIGNATURE OF GROOM~
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Sara Marie Raymond
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Voila ro
(OPTIONAL. SEE REVERSE) 087 68 2478
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C, CHECK ONE 0 CITY 1!'1 TOWN 0 VILLAGE
~~~CIFY East Fishkill
D. STREET ADDRESS 453 Route 376 ZIP 12533
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES tJ NO
02 /08 /1'984
MONTH DAY YEAR
13. A. AGE 23
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Nurse
B, TYPE OF INDUSTRY OR BUSINESS Dutchess Ctr. Rehab.
15. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Georae Russell Raymond
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Justine M. Martin
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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONlli DAY
D. ARE ANY FORMER SPOUSE(S) AUVE? 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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
",- YEAR
o
o
o
1ST
2ND
3RD
SE
23. SUBSCRIBED AND SWORN AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the any person authorized by New York Domestic
Relations Law ~11to perform marriage ceremonies within New York Stat THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for the urpose of a second or subsequent ceremony.
24. TOWN OR CI Cl-ERKC M t 25. A. SOLEMNIZATION PERIOD BEGINS
n . as erson
w
en
z
w
o
::::i
~
{ SEAL }
'-v-I
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
STREET
30. WITNESS TO CEREMONY
NAME (PRINT) Mil R ~ 11 f(. e T
o
o
o
TIME
MONTH
YEAR
MONTH
YEAR
ZIP
AM 07
02:43pM
03 2007
06
2007
09
1~
28. PLACE WHERE MARRIAGE OCCU~ , I
A. STATE NEW YORK B. COU~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY ,^-J G~; ~p I
NAME (PRINT)
SIGNATURE~