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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Brian Daniel Comitto
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c; 1368 .
~~~I:~~R 168
1 . A. FULL NAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 096-72-7853
D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY cY TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 7 E Surrey Lane ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES d NO
3. A AGE 26 3B. DATE OF BIRTH 03 / 31 / 198
MONTH DAY YEAR
4. EMPLOYMENT
A, USUAL OCCUPATION Maintenance
B. TYPE OF INDUSTRY OR BUSINESS Mt. Kisco Medical Group
5. PLACE OF BIRTH Carmel, New York
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Joseph Vincent Comitto
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Linda Maureen Guerrieri
B. COUNTRY OF BIRTH U S A
1
B. NUMBER OF THIS MARRIAGE
B. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEA~
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
1ST
2ND
3RD
4TH
I duly swear/affinn, dep.ose and say,
as to my right to enter into the m
21. SIGNATURE OF GROOM ~
I
STATE FILE NUMBER
(TH/S SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Maria Fertucci
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Comitto
(OPTIONAL. SEE REVERSE) 064-66-5678
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY c:t TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 7 E Surrey Lane ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES D'" NO
10 / 21 /1981
MONTH DAY YEAR
13. A AGE 24
38. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Marketin8 Director
B. TYPE OF INDUSTRY OR BUSINESS ounty Dental
15. PLACE OF BIRTH Mount Kisco, New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A NAME Salvatore James Fertucci
'B. COUNTRY OF BIRTH USA
17. MOTHER
A MAIDEN NAME Roseann Rose Economico
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
lB. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV~RCE CIVIL ANNtlLMENT
DE^QH
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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. - YEAR
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
wledge and belief that the information I provided is true and that I declare th
o 0
o 0
o D
o 0
o legal impediment exists
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STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
SIGNATURE.
DOH-BB (0312006)
10/18/2006
MONTH
YEAR
USE C
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK.
This license. authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11to 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 ~L~RK C M t 25 A SOLEMNIZATION PERIOD BEGINS
r- -'\ JOnn . as erson . .
{ } NAME (PRINT)
SEAL SIGNATURE. ~ C ~~ DATE 10/18/200 TIME MONTH YEAR
"-,-' ""'2'O'f!W1lI ~~h Rd, appinger Falls, NY 12590 06:0h: 10 19 2006
STATE ZIP
27. TYPE OF CEREMONY
o 0 RELIGIOUS
B 0 OTHER, SPECIFY
12
17 2006
1 tr6tVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY --:I2u:rc.J.fJ.l
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) ./
D CITY OF 0 TOWN OF c!""'VILLAGE OF
SPECIFY WMJPIn;bf..~~
NAME (PRINT)
SIGNATURE.