025
+
!z
w
en
w
III
C
B
:I:
en
z
o
~
Iii
a
w
a:
w
(!l
<
a:
a:
~
IS
~
(,)
Ii:
>=
a:
w
(,)
w
a:
w
~
en
en
w
a:
g
<
it
(3
W
Q.
en
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Davie Carino
MIDOLE CURRENT SURNAME
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~c: 1368 .
~5~I:J~R 25
1. A. FULL NAME
FIRST
I
5TATE FILE NUMIII:H
(THIS SPACE FOR STATE USE ONLY)
Q.
N
B. BIRTH NAME, IF DIFFERENT
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Nicole Marie Meehan
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 094 78 1033
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY cY TOWN 0 VILLAGE
~~CIFY Wappinger
1283 Route 376
12590
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Carino
(OPTIONAL - SEE REVERSE) 116 66-4438
D. SOCIAL SECURITY NUMBER -
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY oo'TOWN 0 VILLAGE
~~CIFY WappinQer
D. STREET ADDRESS 1283 Route 376 ZIP 1259C
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VI14GE? 0 ~ d,
13. A. AGE 24 3B. DATE OF BIRTH 03 / 01 Y19f
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Financial Analvst
B. TYPE OF INDUSTRY OR BUSINESS Chase & Company
15. PLACE OF BIRTH NewburQh, New York
(CITY, STATE I COUNTRY IF NOT USA)
16.. FATHER
A. NAME Patrick Sean Meehan
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Susan Ann Hotzler
B. COUNTRY OF BIRTH USA
16. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
~
(3) 0 ANNULMENT (2) 0 DEi
/ /
.'- YEAR
B. HOW DID LA5T 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 INFORMAl
DATE OF DECREE PLACE ISSUED AGAINST WH'
(MONTH, DAY, YEAR) (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUE
1ST 0 1ST 0 0
a:' 2ND 0 2ND 0 0
w
!i 3RD 0 3RD 0 0
~ 4TH 0 0
Q
:ii I duly swear/affirm, dep.ose and o legal impediment exi
Iii as to my right to enter into the .
w
a:
Ii; 21. SIGNATURE OF GROOM ~
+
~~z W
2-0
[jj~>= ~
a:"';S ct
t;;ffi~ 0
:lOW
~(!l5 u:
!z;1;Ul -
~~15 ~
!taUl W
~~~ 0
~~IO
o~z
Z:J_
ZIP
D. STREET ADDRESS
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE 25 3B. DATE OF BiRTH 1 0 / 26 /
MONTH DAY
DYES ct' NO
198
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Construction
B. TYPE OF INDUSTRY OR BUSINESS T. J. R.
5. PLACE OF BIRTH Bronx. New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
~
-s;
ct
C
u:
u..
ct
A. NAME Antonio Carino
B. COUNTRY OF BIRTH Italv
7. MOTHER
A. MAIDEN NAME Anna Marie Cedrone
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
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
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
W
en
z
W
o
::i
DATE 04/13/200
authorized by New York Domest
urpose of a second or subsequent ceremony.
25. A. SOLEMNIZATION PERIOD BEGINS
TIME
MONTH
DATE 04/13/200
appinQer Falls, NY 12590
TATE ZIP
SIGNATURE~
DoH-98 (0312006)
AM
02:0~M
04
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF tlf VILLAGE OF
SPECIFY~
SIGNATUR