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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~c: 1368 .
~~~I:J~R 124
1, A. FUll. NAME
Vincent .Joseph Muscat
MIDDLE CURRENT SURNAME
FIRST
B, BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 1 06 54 9669
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~CIFY Wappingers Falls
D. STREET ADDRESS 7 Veterans Place ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 1!5 YES 0 NO
3. A. AGE 44 3B. DATE OF BIRTH O? / 1 ~ / 1 ~n~
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Self Employed
B. TYPE OF INDUSTRY OR BUSINESS Construction
5. PLACE OF BIRTH Cold Sprina. New York
(CITY, STATE I COUN'I'RY IF NOT USA)
6. FATHER
A. NAME Pasquale .Joseph Muscat
B. COUNTRY OF BIRTH U S A
7, MOTHER
A. MAIDEN NAME Lorraine Anne Serafin
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARF,lIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID lAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEA1l1
C. DATE LAST MARRIAGE ENDED? 05 / 31 / 2005
MONTH DAY YEAR
0, ARE ANY FORMER SPOUSE(S) ALIVE? &'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
1ST 05/31/2005 Pouahkeeosie. New York r':1
DEATH
o
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Karen E Cherv
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT N n II
c. SURNAME AFTER MARRIAGE r. h e ry
(OPTIONAL - SEE REVERSE)097 62 1143
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDRESS 7 Veterans Place ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIll.AGE? tJ YES 0 NO
O~ /04 ;(qn~
MONTH DAY YEAR
11. A. FUll. NAME
13. A. AGE 4~
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Unemployed
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Bronx. New York
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Albert Noll
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Dorothea Odierna
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
1
B. 'HOW DID lAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) ~ DEATH
C. DATE LAST MARRIAGE ENDED? 12 / 20 /2002
MONTH DAY. ,.- YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES ~ NO
..
20. 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
1ST
2ND
3RD
o 0
o 0
o 0
o 0
a no legal impediment exists
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2ND
3RD
4TH
I duly swear/affirm, dep.ose a d
as to my rightto enter into th
21. SIGNATURE OF GROOM~
TITLE As~C.Ip..\E ~'S~
DATE 8. ,~.o"
125C8
STATE
o
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tJ'I
23. SUBSCRIBED AND SWORN TO/AFFIRMED B
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of he bride and groom named above by any person authorized
W Relations Law !l11 to perform marriage ceremonies within New Yo State, THIS LICENSE VALID IN NEW YORK STATE ONLY.
en 0 If checked, this license is to be used only for the UrpDS6 of a second or SUbS6 uent ceremony.
Wz ~ 24. TOWN OR CITYCLERK . . 25, A. SOLEMNIZATION PERIOD BEGINS
o { } NAME (PRINT)' .~.
:::::i SEAL ~~~~1t~~ ~s; . ".' , DATE 08/14/2006 TIME AM MONTH YEAR
'-v-I ~U Mio< lebush Rd, WappinQer Falls, NY 12590 12:27 PM 08 15 2006
STREET CITY/TOWN STATE ZIP
~~~~~RT~~J IO~O~~N~:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 ~ELlGIOUS
DATE AND AT THE TIME AND Q
PLACE INDICATED. I I tlb 9 0 OTHER, SPECIFY
NAME (PRINT)
SIGNATURE~
DOH-98 (0312006)
/14/2006
by New York Domestic
MONTH
YEAR
10
13 2006
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTYOUffM!i:S
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
[!!" CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY "'ll ea UJ h
31. WITNESS TO
NAME (PRINT)
SIGNATURE~