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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Philip John OiNonno. IV
FIRS MIDD
15T 0 0 15T 0
2ND 0 0 2ND 0
3RD 0 0 3RD 0
4TH 0 0 4TH 0
I, being duly sworn, depose 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 impedi
as to my right to enter into the marriage s~ate.
21. SIGNATURE OF GROOM ~
COUNTY [)I~~
CITYiTOWN Wappinger
DISTRICT 13SA
NUMBER
REGISTER 32
NUMBER
1. A. FULL NAME
CURRENT SURNAME
0-
N
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 07"-TJ-7787
2. RESIDENCE A. N~TXOrlc B. ~es:j
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND .AI- .
SPECIFY v~ppn~
o STREET ADDRESS 33 \NIdmer RMd ZIP 1?~M
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES '" NO
M~ / ~1v / ~R19
38. DATE OF BIRTH
3 A. AGE 26
4. EMPLOYMENT
A. USUAL OCCUPATION AlltnmCJtjvfl! T ~
8. TYPE OF INDUSTRY OR BUSINESS B S B A.rtn Sper.Jellsts
5. PLACE OF BIRTH ~~~''N_ York
6. FATHER
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A NAME Philip.l [1iNOf'no, III
8. COUNTRY OF BIRTH II S A
7. MOTHER
A MAIDEN NAME Felicia Zullo
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
(2) 0 DEATH
o
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
C. DATE LAST MARRIAGE ENDED?
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 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
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(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kira~e Mary iji~ COU~ENT SURNAME
11. A. FULL NAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. S~~~~5NW~~~:~~e~~s~Nonno
o SOCIAL SECURITY NUMBER 082.04-1297
12. RESIDENCE A NewAXlodc B D~
C. CHECK ONE 0 CITY IV" TOWN 0 VILLAGE
~~~CIFY East F~hkill
o STREET ADDREss21~ OAk RI. ROAd ZIP 12533
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES'" NO
13. A. AGE 25 13.B. DATE OF BIRTH rw:t. ..(.... ~
"IIIIl:lNTH ~AY ~AR
14. EMPLOYMENT
A. USUAL OCCUPATION Office Manager
B. TYPE OF INDUSTRY OR BUSINESS Toni Phil Entea:pdses
15. PLACE OF BIRTH ~~N~Yoa:k
16. FATHER
A. NAME Dennis Keith Cou1ta5
B. COUNTRY OF BIRTHCanada
17. MOTHER
A. MAIDEN NAME Olane elizabeth KoeIfgeA
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
o
o
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
C. DATE LAST MARRIAGE ENDED?
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
DATE Q4/19fXVlR
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 the bride and groom named above by any person authorized
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 CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
TIME MONTH
DATE 04119f?lYlR
10:12 ~~ 04
TAT ZIP
27. TYPE OF CEREMONY
o 0 RELIGIOUS 1 ~
9 0 OTHER, SPECIFY
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{ SEAL }
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NAME (PRINT)
SIGNATURE ~
MAILING ADORES
I
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
11.'5~~ f):) t1 r/; tft;
ST
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29. OFFICIANT
NAME (PRINT)
SIGNATURE ~
MAILING ADDRESS
STREET CITYiT N
3D. WITNESS TO CEREMONY
NAME (PRINT) P);1 /(.../r'" J j)" ~,#/# d
SIGNATURE~ ~
DOH-9B (11/98)
YEAR
MONTH
YEAR
20
2006
06
18 2006
,4'7
TITLE
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNT'i~~'/~I?l
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ OF 0 VILLAGE OF
SPECIFY 1~~5-t11')J1,...J
DATE~r4- t:
STATE
31.
NAME (PRINT)
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