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N
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseph Y ozzo
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
~~~~:f~ 1368 .
~5~I:J~R 167
L A. FULL NAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 110-72-7043
D. SOCIAL SECURITY NUMBER
2. RESIDENCE'" New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY cY TOWN 0 VILLAGE
~~CIFY Wappinqer
D. STREET ADDRESS 223 Chelsea Cay ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES d NO
3. A. AGE 28 3B. DATE OF BIRTH 08 / 23 / 197
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION
Retail
B. TYPE OF INDUSTRY OR BUSINESS Hillman Group
5. PLACEOFBIRTH North Tarrytown, New York
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Gregory Henry Yozzo, Jr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Suzanne Marie Holdner
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARF,lIAGE 1
9. ~~~~~~J'RMO~R~If~8us 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
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
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
Lo
.-J
SUPPLEMENTAL FILE
FROM THE BRIDE
Jo Anna Romano
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. 81RTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Y OZZO
(OPTIONAL. SEE REVERSE) 132-68-3107
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY of TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 223 Chelsea Cay ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES d NO
01 /27 /1975
DAY YEAR
13. A. AGE 31
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Registered Nurse
B. TYPE OF INDUSTRY OR BUSINESS Vassar Med. Ctr.
15. PLACE OF BIRTH Queens, New York
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Thomas Romano
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Elisa Giacomino
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?
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.'- YEAR
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) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I duly swear/affirm, aep'ose and say, that to the best of my knowledge and belief that the information I provided is true an~t
as to my right to enter into th~ marnage state. ,;Y~'
21. SIGNATURE OF GROOM~ -, . SIGNA RE OF BRID~
o 0
o 0
o 0
o 0
eClare_=2 impediment exists
USE CURRENT NAME
23. SUBSCRIBED AND SWORN TO/AF ED FOR
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New 'York Slate of the ride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New York Slat. 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 CL RK 25. A. SOLEMNIZATION PERIOD BEGINS
n C. Masterson
~
{ } NAME (PRIm)
SEAL SIGNATURE ~
'-v-I MAILI~ttM~S
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
DATE
10/13/2006
by New York Domestic
TIME
MONTH
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
DAY
YEAR
YEAR
MONTH
Ie DATE 10/13/200
ush R ,Wappinger Falls, NY 12590
ClTYrrOWN STATE ZIP
26. SOLEMNIZATION OCCURRED OF CEREMONY
TIME M. DAY YEAR
,,-,0
~
AM
01 :11>M
10
14
2006
12
12 2006
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYM~
C. LOCATION OF CEREMONY
(CHECK ONE ANI}.8PECIFY)
o CITY OF ilt'TOWN OF 0 VILLAGE OF
SPECIFY ~..
STATE