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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Richard Nannetti. II
MIDDLE CURRENT SURNAME
USE C RE
23. SUBSCRIBED AND SWORN TOIAFF. D BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This IiCBnse authorizes the marriage in New York State authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New Yo State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this liCBnse is to be US d only for the purpose of a second or subsequent ceremony.
24. TOWN OR CITY L RK ..f:" M t 25 A SOLEMNIZATION PERIOD BEGINS
i"';" as erson . .
NAME (PRINT) ,; ." TIME
COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c; 1368 .
~5~~J~R 135
1. A. FULL NAME
FIRST
..
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL-SEE REVERSE) 110-72-6715
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r!'" TOWN 0 VILLAGE
~~~CIFY WappinQer
D. STREET ADDRESS 12H White Gate Drive
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r:f NO
01 / 13 / 198
MONTH DAY YEAR
3. A. AGE 22
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION A V Technician
B. TYPE OF INDUSTRY OR BUSINESS Electricians
5. PLACE OF BIRTH Bronx, New York
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Richard Nannetti
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Patricia Ann Capaccio
B. COUNTRY OF BIRTH USA
1
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEAcr
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
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
o
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{ SEAL }
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01 :2~~
08
23 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.
CITYITDWN
26. SOLEMNIZATION OCCURRED
TIME M. DAY YEAR
I
STATE FILE NUMBER
(TH/S SPA9E FOR STA TE USE ONL Y)
-,
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Sara Marie Gage
MIDDLE CURRENT SURNAME
-1
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Nannetti
(OPTIONAL - SEE REVERSE) 575-31-1927
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY D"" TOWN 0 VILLAGE
~~CIFY Wap~inger
D. STREET ADDRESS 12H White Gate Drive ZIP. 12b90
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
12 /26 /1982
MONTH DAY YEAR
13. A, AGE 23
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Licensed Vet. Technician
B. TYPE OF INDUSTRY OR BUSINESS Comm. Animal Hosp.
15. PLACE OF BIRTH llion, New York
(CITY, STATE I COUNTRY IF NOT USA)
16, FATHER
A. NAME Robert Lenor Gage, Jr.
'B. COUNTRY OF BIRTH USA
17. MOTHER .. b
A. MAIDEN NAME Madeline Marie New erry
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL AN~LMENT
DE1r
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) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.'- YEAR
o 0
o 0
o 0
o 0
at no legal impediment exists
08/24/2006
MONTH
YEAR
MONTH
YEAR
2006
10
STATE
27. TY~F CEREMONY
o &'RELIGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~GE OF
SPECIFY~
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NAME (PRINT)
SIGNATURE~
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ZIP
NAME (PRINT)
SIGNATURE~