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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Jat\~ Paul M~lCone
couNnOutchess
CITY/TowNWappinger
~~J~~c:1368
REGISTE'3a
NUMBER
1. A. FULL NAME
CURRENT SURNAME
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B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSEJ.,
D. SOCIAL SECURITY NUMBER -u63-60. 1022
2 RESIDENCEA.N~AX)Ork B. Dm~ss
C. CHECK ONE 0 CITY IlI!J TOWN 0 VILlAGE
~~~CIFY East Fishkill
D. STREET ADDREss4.n Tigp.r Road ZIP 12533
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIULAGE? 0 YESotJ NO
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3. A. AGE29
4. EMPLOYMENT
38. DATE OF BIRTH
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A. USUAL OCCUPATION Spray Tech
B. TYPE OF INDUSTRY OR BUSINESS ~iP-d ~p.dar Trp.p. ~o
5. PLACE OF BIRTH~S~y~~Xnrk
6. FATHER
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A. NAME John Paul Ma'7"7acone
8. COUNTRY OF BIRTH l' 5 A
7. MOTHER
A. MAIDEN NAME GIORS MaRe Cunningham
B. COUNTRY OF BIRTH 1..1 S A
8. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH
1 n P
B. HOW DID LAST MARRIAGE END? (3)~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? n9 /"5 / 7nn~
MONTH'" DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
(TH/S SPACE FOR STATE USE ONL Y)
L D SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. FULLNAMEI aura Ann Martino
FIRST MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Ma77ar.nnp.
D. sJ~~~'~~;JRiT~E;U~~~~RSE)117-58-31fi4
12. RESIDENCE AN'TXerk . B.D~~a'tt~S
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND _u. .
SPECIFYII.,applnger
D. STREET ADDRES~ 10 Malonev Road P2
ZIP 12603
o YES'fJ NO
1Qfi~
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIULAGE?
:ri
13. A. AG~1
02
MONTH
13.B. DATE OF BIRTH
DAY
14. EMPLOYMENT
A. USUAL OCCUPATIONMedical Billing
B. TYPE OF INDUSTRY OR BUSINEssEthan Alen staffina
15. PLACE OF BIRTHYonke"i-lc New York
(CITY, STATElCOUNTRY IF NOT USA)
16. FATHER
A. NAMEP-a~qlJalp. Martino
B. COUNTRY OF BIRTilJ SA'"
17. MOTHER
A. MAIDEN NAME Diape Fa1cnnp.
8. COUNTRY OF BIRT~ J S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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1ST 09lO512DD3 Poughkeepsie. N Y ~ 0 1 ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the Information I provided IS ~trued that I declare that no legal Impediment eXists
as to my right to enter Into the marriage state. c--;:-v
21 SIGNATURE OF GROOM ~ -e 22. SIGNATURE OF BRIDE ~ ~ ~ M rJ~
USE . USE CURRENT NAME
DATE 04/26/2006
by New York Domestic
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of t e bride and groom named above by any person authorized
Relations Law !l11 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 CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
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NAME (PRINT)
TIME
MONTH
YEAR
MONTH
YEAR
DATE (\4"Ill7n06
AM
06:23 PM 04
25 2006
27
2006
06
ZIP
ST
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
TATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
1 IJ( CIVIL
TITLEf=iMA1Ge ~~~#1.q I
DATE /f/i!!/.. 2/ .;&~,
i-IS /lLt;, I: .5 '/'
STATE
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
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SIGNATURE ~ / }4!t!N~~;f{ &Lt/'
MAILING ORE
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NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY })vrc.if6S.5.
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF j1( VILLAGE OF
SPECIFY p.k-l1'll'f~as. f7j.~JS
NAME (PRINT)
SIGNATURE ~