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tlat to ttle beS~Wledge and belief that ttle information I provided is true
mage state.
, 2 IGNATURE OF BRIDE~
USE RR NT
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State auttlorized by New York Domestic
W Relations Law ~11 to perform marriage ceremonies within New Y State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
en 0 If ctlecked, ttlis license is to be used only for the purpose of a second or subsequent ceremony.
Z ~ 24. TOWN OR CI~8fiW C. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
W { } NAME (PRINT)
o YEAR MONTH
::J SEAL SIGNATURE ~ DATE
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Seamus Padraig Doran
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITY/TOWN Wappinger
~~~~~ 1368 .
~~~:;~R 111
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 151-80-5170
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B. Rockland
(STATE) (COUNTY)
C. CHECK ONE 0 CITY I!f' TOWN 0 VILLAGE
~~CIFY Ramapo
D. STREET ADDRESS 48 Bon Aire Circle
ZIP 10901
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES ~ NO
11 / 26 / 197
MONTH DAY YEAR
3. A. AGE 31
3B. DATE OF BiRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Telecom Manager
B. TYPE OF INDUSTRY OR BUSINESS Ramapo College
5. PLACE OF BIRTH Wyandotte, Michigan
(CITY, STATE I COUNTRY IFNOT USA)
6. FATHER
A. NAME James Doran
B, COUNTRY OF BIRTH Ireland
7. MOTHER
Donna Jean Schmitt
A. MAIDEN NAME
USA
B. COUNTRY OF BIRTH 1
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV05CE CIVIL ANNdLMENT
DE1r
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
10. 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
2ND
3RD
4TH
I duly swear/affirm, dep.ose and
as to my right to enter into the
21. SIGNATURE OF GROOM~
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Andrea Christina Boccio
MIDDLE CURRENT SURNAME
--1
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Boccio - Doran
(OPTIONAL - SEE REVERSE) 097-58-2048
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE)....; (COUNTY)
C. CHECK ONE 0 CITY L:J TOWN 0 VILLAGE
AND W .
SPECIFY ap~lnger
D. STREET ADDRESS 1 08 Edgehlll Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES ~ NO
04 /20 /1976
DAY YEAR
13. A. AGE 30
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDU!U.RY OR,BI,ISINESS Pok. City Sch. LJISt.
15. PLACE OF BIRTH t-'ougnKeepsle, New York
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME John Michael Boccio
'B. COUNTRY OF BIRTH USA
17. MOTHER DIM' C . I'
A. MAIDEN NAME 0 ores arle aprlo I
B. COUNTRY OF BIRTH U S ~
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV8RCE CIVIL AN~LMENT
DEfJH
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) (CITY/COUNTY. STATElCOUNTRY. IF NOT USA) SELF SPOUSE
o 0
o 0
o 0
o 0
al impediment ~xists
YEAR
ZIP
STATE
27. TYPE OF CEREMONY
o ~L1GIOUS
9 0 OTHER, SPECIFY
STREET CITYITOWN
~~~~R~~J IO~O~~N~Z:~ 26. SOLEMNIZATION OCCURRED
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR
DATE AND AT THE TIME AND rY1 AM
PLACE INDICATED. ~ O~ - I a. - J.I)P/P
w
5 ~~~::1i 1<ew. f{~ G-.~
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ffi l>.b. "eo'll ~8 ~g;--:rUr.J(.,+iOiv ,
o STREET ' CITY/TOWN
30. WITNESS TO C
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~
C. LOCATION OF CEREMONY
(CH~ ONE AND SPECIFY)
V CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY ~ OJ.. fJ. 0 g~ ~
10 CIVIL
TITLE '"Rc M-.IW CA-n-foI'iC-. Pf';~
DATE .lug. I J. ~ rl()(Xp
rJ-e<>> Yor(C 1.:lS33
STATE ZIP
31. WITNESS TO CEREMONY
\
NAME (PRINT) ~'
SIGNATURE~
NAME (PRINT)
SIGNATURE.
DOH-QR 10312006\
