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COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~~ 1368 .
~~~I~;~R 20
~ I A It: Ut" Nt:W YUHI\.
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Aaron James Titka
MIDDLE CURRENT SURNAME
FIRST
(THIS SPACE FOR STA TE USE ONL Y)
'.
."
Nor
/1,:;&0
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
B rittanJb~ icole Ra~i~~~T ~URNAME
~
1. A. FULL NAME
11. A. FULL NAME
FIRST
a.
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Titka
(OPTIONAL - SEE REVERSE) 04 7 -78-6146
D, SOCIAL SECURITY NUMBER
12. RESIDENCEA.New York B Dutchess
(STATl') (COUNTY)
C. CHECK ONE ~ CITY 0 TOWN 0 VILLAGE
~~~CIFY Pouqhkeepsie
D, STREET ADDRESS 134 Innis Ave; K 19 ZIP 12601
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? '6 YES 0 NO
13, A, AGE 20 3B. DATE OF BIRTH 04 /03 A986
MONTH DAY YEAR
C, SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)085 72 9536
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE olJ CITY 0 TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D. STREET ADDRESS 134 Innis Ave; K 19 ZIP 12601
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? r1 YES 0 NO
10 / 27 / 1986
MONTH DAY YEAR
3. A. AGE 20
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Military
B. TYPE OF INDUSTRY OR BUSINESS United States Army
5. PLACE OF BIRTH Poughkeepsie. New York
(CITY, STATE / COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Medical Assitant
B. TYPE OF INDUSTRY OR BUSINESS Medical
15, PLACE OF BIRTH Hartford , Connecticut
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Thomas Alfred Rabideau
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Cynthia Ann Steinberq
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
6. FATHER
A. NAME James Allen Titka
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Lynn Marie Wilson
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
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / (.
MONTH DAY YEAR
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
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D NO
10. 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
21. SIGNATURE OF GROOM ~ .'
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
e best of my knowledge and belief that the information I provided is tr
US
23. SUBSCRIBED AND SWORN TO/AFFIRM D BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New ork State the bride and groom named above by any person authorized
Relations Law !l11 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) John C. M sterson
TIME MONTH YEAR
SEAL SIGNATURE ~. DATE 03/21/2007
'-v-' MAI~OG~fddl~ , Wappinqer Falls, NY 12590 06:45~~ 03
STREET CITY/TOWN STATE ZIP
~~~R~:RT~~~ IO~O~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 00 RELIGIOUS
DATE AND AT THE TIME AND AM
PLACE INDICATED. PM 9 0 OTHER, SPECIFY
by New York Domestic
MONTH
YEAR
05
20 2007
22
2007
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY
29. OFFICIANT
NAME (PRINT)
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
TITLE
o CITY OF 0 TOWN OF 0 VILLAGE OF
SIGNATURE ~
MAILING ADDRESS
DATE
SPECIFY
STREET
30. WITNESS TO CEREMONY
CITYrrOWN
STATE
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~
DOH-9B (0312006)
NAME (PRINT)
SIGNATURE~