097
+
!z
W
Ul
W
III
9
::>
o
:I:
Ul
Z
o
~
c;
W
0::
W
~
~
0::
<
~
u.
o
W
!;(
t.l
ii:
~
W
t.l
W
0::
W
i
Ul
Ul
W
0::
o
o
<
~
U
W
0..
Ul
w
-UJ
Z
-w
o
::i
+
Z' .
a:i:5 W
~~~ t::
~ffiz .....
Ul..J:li 0
::>t.lgW
:li(!l u:
!zl!; -
~~~ ~
iEOUl W
~~~ 0
l!!!!11O
O~
Z::il!;
1. A. FUU. NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDA Vir, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael Anthonv Guadagno
FIRST MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
COUNTY Dutchess
CITYfTOWN Wappinger
~~~~; 1368 .
~5~~J~R 97
.J
0..
N
B. BIRTH NAME, IF DIFFERENT
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Tracy Lynn Colucci
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Merrell
c. SURNAME AFTER MARRIAGE Guadagno
(OPTIONAL - SEE REVERSE) 112-50-3350
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE)..J (COUNTY)
C. CHECK ONE 0 CITY L::J TOWN 0 VILLAGE
~~CIFY Wappinger
D. STREET ':;;;-68 Scott Drive ZIP. 12b9U
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
07 /04 )1'963
DAY YEAR
11. A. FUU. NAME
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 124-54-9182
D. SOCIAL SECURITY NUMBER
2. RESlDENCEA. New York B. Dutchess
(STATE) oJ (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY WaP.2inger
D. STREET ADDRESS 68 Scott Drive ZIP. 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 6 NO
08 / 04 / 1960
MONTH DAY YEAR
13. A. AGE 43
3B. DATE OF BIRTH
3. A. AGE 45
MONTH
3B. DATE OF BiRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUliT,RY OFj BUSINES~ KIWI School
15. PLACE OF BIRTH Nurnoerg, (,jermany
(CITY, STATE I COUNTRY IF NOT USA)
4. EMPLOYMENT
A. USUAL OCCUPATION Letter Carrier
B. TYPE OF INDUSTRY OR BUSINESS U. S. Postal Service
5. PLACEOFBIRTH Bronx, New York
(CITY, STATE I COUNTRY IF NOT USA)
t-
:>
II(
-0
u:
u.
-II(
6. FATHER 16. FATHER
A. NAME Alfred Guada~no A. NAME Edward Leroy Merrell, Jr.
B. COUNTRY OF BIRTH US' B. COUNTRY OF BIRTH USA
7. MOTHER 17. MOTHER M L S k' .
A. MAIDEN NAME Frances Andreassi A. MAIDEN NAME ary ynn zyn lewlcz
B. COUNTRY OF BIRTH Italy B. COUNTRY OF BIRTH U S A2
l
8. NUMBER OF THIS MARF,lIAGE 18. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES 19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO~CE CIVIL AN~LMENT DEfjH DIVfRCE CIVIL AN~LMENT
~ ~
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORC07 (3) 0 ~~LMENT 1 ~~TH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORff? (3) ~NULMENT 19~9 DEATH
c. DATE LAST MARRIAGE ENDED? / / C. DATE LAST MARRIAGE ENDED? / /
MONTH~ DAY YEAR MONTH~ DAY' ".- YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
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
(~P.AX1 ~ C(CITYICOU~~ !jTATElCQIINTfl,Y, IF NOT USA) SELF SPOU.1 (~l:I. ~I\'" X~ C (9ITYJCO\lNT'(, .s!ATffl~' IF NOT USA) SELF SPO~E
1ST UflU'd/' 'd'df armel, New YOrK 0 0 1ST UfU:lrI'd':j( armel,l'\Jew or 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I duly swe!lr/affinn. dep.Dse and say, that to the best of my nowledge and belief that the infonnation I provided is true and that I declare that no legal impediment exists
as to my nght to enter Into the_mafriage s~te, () . ~ ...0 /' )... 1
21.S1GNATUREOFGROOM~ ~ 22.SIGNATUREOFBRIDE~ c7-- (~
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ~~E CUR . USE CURRENT NAME 07/14/2006
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perfDnn marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked. this license is to be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CI~ C. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
D~H
I
c
~
E
~
~
{ SEAL }
'-v-I
YEAR
YEAR
MONTH
SIGNATURE ~
MAI~
2006
09
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29. OFFICIA:- ~
NAME (PRINT)
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. Cou:&ll n ~
C. LOCATION OF CEREMONY
(CHECK ONE AND ~IFY)
o CITY OF ~WN OF 0 VILLAGE OF
SPECIFY ~ 46"" ~$~ (j, L,L,...
SIGNATURE~
DOH-98 (0312006)
NAME (PRINT)
SIGNATURE~