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COUNTY Dutchess
CITYrrOWN Waooinqer
~~~:~; 1368 '
~5~1~~R 116
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
~
L 0 SUPPLEMENTAL FILE
L A. FUll NAME
JoseBh Frank Varrone
MI OLE CURRENT SURNAME
FROM THE BRIDE
Helen Piteo
FIRST MIDDLE CURRENT SURNAME
B, BIRTH NAME (MAIDEN NAME), IF DIFFERENT Eleni Kotopoulos
c. SURNAMEAmRMARRIAGE Piteo-Varrone
(OPTIONAL - SEE REVERSE) 065 62 6558
D, SOCIAL SECURITY NUMBER --
12, RESIDENCE A, New York B, Dutchess
(STATE) (COUNTY)
C, CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Waopinqer
D. STREETADDREss21 Woodland Court ZIP 12590
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES ~ NO
04 /09 /1'964
MONTH DAY YEAR
11. A, FUll NAME
FIRST
B, BIRTH NAME, IF DIFFERENT
C. SURNAME AmR MARRIAGE
(OPTIONAL - SEE REVERSE) 0
D. SOCIAL SECURITY NUMBER 089-52-07 4
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY!!!'1 TOWN 0 VILLAGE
~~~CIFY Waopinaer
D. STREET ADDRESS 21 Woodland Court ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
07 / 23 / 1958
MONTH DAY YEAR
13. A. AGE 42
3B. DATE OF BIRTH
3. A. AGE 48
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Interior Desi~n
B. TYPE OF INDUSTRY OR BUSINESS Interior Design
15. PLACE OF BIRTH Lamia, Greece
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Nicholaos Kotopoulos
'B. COUNTRY OF BIRTH Greece
17. MOTHER
A. MAIDEN NAME Alexandria Diamondopoulos
B. COUNTRY OF BIRTH Greece
lB. NUMBER OF THIS MARRIAGE 2
4. EMPLOYMENT
A. USUAL OCCUPATION Sales Marketina
B. TYPE OF INDUSTRY OR BUSINESS Consultin~
5. PLACE OF BIRTH Queens, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Anthonv Varrone
B. COUNTRY OF BIRTH Italy
7. MOTHER
A. MAIDEN NAME Mary Valenti
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 2
9 PREVIOUS MARRIAGES 19. PREVIOUS MARRIAGES
. A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH DIVORCE CIVIL ANNULMENT DE~TH
1 0 0 1 0 U
B. HOW DID LAST MARRIAGE END? (3) dDIVORCE (3) 0 ANNULMENT ~) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) t1DIVORCE (3) 0 ANNULMENT ~ ~ DEATH
C. DATE LAST MARRIAGE ENDED? 02/ 23 / 2u04' c. DATE LAST MARRIAGE ENDED? 10 / 17 /20
MONTH" DAY YEAR D. ARE ANY FORMER SPOUSE(S) ALIVEM?ONTfVYES DONAYO " - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO 0 '
..
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY. STATEICOUNTRY, IF NOT USA) SELF SPOUSE (MO~H, DAY, YEAR) (CITYlCOyNTY, STATFfCOU,.N1RY, IF ~qT UliA) SELF SPOUSE
1ST 02/23/2004 poughkeepsie, New York r1 0 1ST 10/17/2001 PoughKeepSIe, New YOrK 0 r5
2ND 0 0 2ND 0 0
~ 0 0 ~ 0 0
4TH 0 0 4TH 0 0
I duly swear/affirm, dep.ose and say, that to t ledge and belief that the information I provided is true and th t no legal impediment exists
as to my right to enter into the mamage
21. SIGNATURE OF GROOM ~
USE CUR
23. SUBSCRIBED AND SWORN TOI lAMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New Y State of the bride and groom named above b any person authorized
W Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
en 0 If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
Z ~ 24. TOWN OR CITY.J CI,.ERKC M t 25. A. SOLEMNIZATION PERIOD BEGINS
W NAME (PRINT) onn . as er on
~ {SEAL} SIGNATURE ~ .
MAI'2'O' MP~
'-v-I
E
08/07/2006
by New York Domestic
YEAR
10
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.
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY -;;)t7iZJI1fIB
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~N OF 0 VILLAGE OF
SPECIFY uJAPP, if:/;~,z&
SIGNATURE~
OOH-98 (0312006)
NAME (PRINT)
SIGNATURE~