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COUNTY Dutchess
CITYrrOWN Wappinger
~~~~ 1368 '
~5~:J~R 82
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
AnSbr~ AlhArt ~~~~SURNAME
I"
STATE FILE NUM15"'"
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Nicole Jill Taglione
MIDDLE CURRENT SURNAME
11, A, FULL NAME
FIRST
1. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAMEAFTERMARRIAGE T~glinne
(OPTIONAL. SEE REVERSE) 6 6 2
D. SOCIALSECURITYNUMBER 077-5 -7 6
12. RESIDENCEA. C~liforni~ B. Oranae
(STATE) (cou'iiii'\')
C. CHECK ONE I!iJ CITY 0 TOWN 0 VILLAGE
~~~CIFY San Clemente .
D. STREET ADDRESS 737 Calle Vallarta ZIP 92673
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? t1 YES 0 NO
06 /12 /1'969
MONTH DAY YEAR
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
D. ~~:~~:~U~e:~RSE) 619-12-1812
2, RESIDENCE A. r.::Jlifnrni;:l B. ()r;:lnne
(STATE) (coUNTYF
C. CHECK ONE Ili!l' CITY 0 TOWN 0 VILLAGE
~~CIFY San Clemente
Do STREET ADDRESS 737 Calle Vallarta ZIP 92673
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? r:! YES 0 NO
3. A. AGE A.~ 3B. DATE OF BiRTH O~ / 31 / 1963
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Manufacturing Manager
B. TYPE OF INDUSTRY OR BUSINESS Alcoa
5. PLACE OF BIRTH Hull. Enaland
(CITY. STATE I COUNTRY IF NOT USA)
13. A. AGE 37
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION IS Director
B. TYPE OF INDUSTRY OR BUSINESS Sage Software
15. PLACE OF BIRTH Pouohkeepsie. New York
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Anthonv Taalione
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Alice Chapman
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 1
6. FATHER
A. NAME John Cocks
B. COUNTRY OF BIRTH Enoland
7. MOTHER
A. MAIDEN NAME Elizabeth Atkinson
B. COUNTRY OF BIRTH Enoland
8. NUMBER OF THIS MARF,lIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
9. ~R~~~~RM~f~~~8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) dDIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID lAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 05/ 18 / 1993' C. DATE LAST MARRIAGE ENDED? / /
MONTH .... DAY YEAR MONTH DAY' - - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? D"l'ES 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
(MONTH, DAY, YEAR) (CITYICOUNTY. STATEICOUNTRY, IF NOT USA) SELF SPOUSE (MONTH. DAY, YEAR) (CITYICOUNTY. STATEICOUNTRY, IF NOT USA) SELF SPOUSE
1ST 05/18/1993 Orange, California d" 0 1ST 0 0
~D 0 0 ~D 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I duly swe!lr/affirm, deP.OSe and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my nght to enter Into the mamage state. ~
21. SIGNATURE OF GROOM" SEC 22. IGNATURE OF BRIDE" ~etf'l ~ c.~I'J/.).'/ L
23. SUBSCRIBED AND SWORN TOIAFARMED BEFORE ME (USE CURR~ 06/26/2006
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 perform 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 CITYJCI,ERK C M t 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) onn . as erson
{TIME MONTH YEAR MONTH
SEAL SIGNATURE ~
MAI~ ~~ AM 06 27 2006 08 25 2006
'-v-I 12:39pM
ZIP
DEATH
o
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ]).;reJ+t5S2
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF J!'. TOWN OF 0 VILLAGE OF
SPECIFY p/Stl i'('/ Li-
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
~CIVIL
Tmlil2me.r... --;;a.~~Cf I
DATE r::;1(;J:.At I. .;(~rJ&.
, Nif, /:z.'5rD
STATE
STREET
==ro"W~: ~
OOH.98 (0312006)
NAME (PRINT)
SIGNATURE ~
31. WITNESS T