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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c: 1368
~5~1:~~R 169
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael James Maffia
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(TH/S SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Stephanie Dee AnQlero
MIDDLE CURRENT SURNAME
~
1. A. FULL NAME
11. A. FUll NAME
FIRST
FIRST
..
N
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Maffia
(OPTIONAL - SEE REVERSE) 083-70-1432
D. SOCIAL SECURI1Y NUMBER
12. RESIDENCEA.New York 6.0ranQe
(ST~1j) (COUNTY)
C. CHECK ONE !J CITY 0 TOWN 0 VILLAGE
~~~CIFY Newburgh
D. STREET ADDRESS 50 Valley Avenue ZIP 12550
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? tJ YES 0 NO
09 /06 ;1'985
DAY YEAR
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 120-58-8293
D. SOCIAL SECURI1Y NUMBER
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY WappinQer
D. STREET ADDRESS 79 Losee Road ZIP 12590
E. IS RESIDENCE WITHIN liMITS OF CI1Y OR INCORPORATED VilLAGE? 0 YES '6 NO
3. A. AGE 30 36. DATE OF BiRTH 06 / 23 / 1976
MONTH DAY YEAR
MONTH
13. A. AGE 21
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION ManaQer
B. TYPE OF INDUSTRY OR BUSINESS. Partsearch Tech.
5. PLACE OF BIRTH Bronxville, New York
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Anthony J. Maffia
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Mary Anne Norberg
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
14. EMPLOYMENT
A. USUAL OCCUPATION Unemployed
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Queens, New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Aldo An~ero
'B. COUNTRY OF BIRTH S A
17. MOTHER
A. MAIDEN NAME Doris Santiago
B. COUNlTRY OF BIRTHPuerto RICO
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIOORCE CIVIL AN~ULMENT
D~TH
DE'CJH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. - YEAR
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) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
0 0 1ST 0 0
0 0 2ND 0 0
0 0 3RD 0 0
0 0
that no legal impediment exists
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23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE
SIGNATURE OF. TOWN OR CITY CLERK~
This license authorizes the marriage in New York State of
Relations Law ~11 to perform marriage ceremonies within New York
o If checked, this license is to be use
~ 24. TOWN OR crr,!, Cl-ERK M t
NAME (PRINT) JOn . as erson
{SEAL} SIGNATURE~
MAI~~ MRJCfle
'-v-I
10/19/2006
DATE
by New York Domestic
e bride and groom named above by any person authorized
tate. THIS LICENSE VALID IN NEW YORK STATE ONLY.
only for the purpose of a second or subsequent ceremony.
25. A. SOLEMNIZATION PERIOD BEGINS
YEAR
MONTH
YEAR
TIME
MONTH
DATE 10/19/2006
ppinger Falls, NY 12590
18 2006
2006
12
AM
02:47 PM
10
20
ZIP
l~L
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COU~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) ./
o CITY OF 0 'fOWN OF cf'VILLAGE OF?,: JL
SPECIFY I/J APlA~ ~
SjGNATURE~
DOH-98 (0312006)
SIGNATURE~