143
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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Edward Joseph Franci~ JR.
FIRST MIDDLE CURRENl SURNAME
I
STATE ALE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
"I
COUNTY Dutchess
CITYrrOWN Wappinqer
~~~:~; 1368 .
~~~~J~R 143
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Vanessa Jo~ Milone
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME. IF DIFFERENT B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE C. SURNAME AFTER MARRIAGE F ranci s
(OPTIONAL' SEE REVERSE) 052 64 3356 (OPTIONAL. SEE REVERSE) 110-72-6024
D. SOCIAL SECURITY NUMBER - - D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B. Dutchess 12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY) (STATE) (COUNTY)
C. CHECK ONE 0 CITY!'l TOWN 0 VILLAGE C. CHECK ONE 0 CITY l!l' TOWN 0 VILLAGE
~~~CIFY Pouahkeepsie ~~CIFY Wappinqer
D. STREET ADDRESS 510 Maloney Rd. Apt. 006 ZIP 12603 D. STREET ADDRESS 1 Alpert Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES ~ NO E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES ~ NO
3. A. AGE 27 3B. DATE OF BiRTH 07 / 19 / 1979 13. A. AGE 28 3B. DATE OF BIRTH 11 /05 /1'977
MONTH DAY YEAR MONTH DAY YEAR
4. EMPLOYMENT
A. USUAl OCCUPATION Drafter
B. TYPE OF INDUSTRY OR BUSINESS Chelsea Modular
5. PLACE OF BIRTH Bronx, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Edward Joseph Francis
B. COUNTRY OF BIRTH U 5 A
7. MOTHER
A. MAIDEN NAME Marianne Mooney
B. COUNTRY OF BIRTH U 5 A
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 Reqistered Nurse
B. TYPE OF INDUSTRY OR BUSINESS 5t. Francis Hospital
15. PLACE OF BIRTH Beacon, New York
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Philip Milone
. B. COUNTRY OF BIRTH U 5 A
17. MOTHER
A. MAIDEN NAME Linda Markman
B. COUNTRY OF BIRTH U 5 A
18. NUMBER OF THIS MARRIAGE 1
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19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEAJH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(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) (CITYICOUNTY. STATEICOUNTRY. IF NOT USA) SELF SPOUSE
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) (CFTYICOUNTY. STATElCOUNTRY. IF NOT USA) SELF SPOUSE
o 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
edge and belief that the information I provided is yue)and that I declare that no legal ~pediment exists
" .SIGNA EOFBRIDE~ V~ )~ ~
USE CURtrri NAME 09/07/2006
DATE
by New York Domestic
USE RR
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 ~11 to perform marriage ceremonies within New York St . THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used on for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CI,.ERK 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) Jon C. Masterson
{SEAL} SIGNATURE ~ .
MAI~ MflJ
'-v-'
YEAR
11
06 2006
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B, COUNTY 7~
C. LOCATION OF CEREMONY
(CHECK ONE AN~PECIFY)
o CITY OF ~TOWN OF 0 VILLAGE OF
SPECIFY G'#51 t1~IIK1LL
SIGNATURE~
DOH-98 (0312006)