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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
PtVDF Joseph ~ffomo
23. SUBSCRIBED AND SWORN TO BEFOR E
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York Sta e 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
COuNTY[tutchess
CITYfTOWNWappinger
~~~~~C;1368
~5~I~J~R14 4
1 A. FULL NAME
CURRENT SURNAME
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B BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEl..
o SOCIAL SECURITY NUMBER -u62 4 4 0164
2 RESIDENCE A. N~AX)Ork B. Dm~AASS
C CHECK ONE 0 CITY 0 TOWN IolJ VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDRESS 14 l.linton ~treet ZIP 12590
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
Jt1H /2~y /1~j7
3 A. AGE38
4. EMPLOYMENT
38. DATE OF BIRTH
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A. USUAL OCCUPATION Plant Mechanic
B. TYPE OF INDUSTRY OR BUSINESS l.Ollnty Asphalt
5. PLACE OF BIRTHP9H~q~~~~~ip, New York
(I, E/ NTRY II' NOT USA)
6. FATHER
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A. NAME Jos'eph A. Baccomo, Jr
B COUNTRY OF BIRTH I J S A
7. MOTHER
A MAIDEN NAME Linda Jean Taylor
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
o n
DEATH
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12) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
13) 0 ANNULMENT
/ /
YEAR
MONTH DAY
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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1ST
2ND
3RD
4TH
I, being duly sworn, depose a
as to my right to enter into the
21. SIGNATURE OF GROOM ~
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{ SEAL}
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NAME (PRINT)
SIGNATURE ~
MAILING ADORE
DATE 11/23/2005
Y 12590
STATE
27. TYPE OF CEREMONY
11
24
2005
01
I
5T ATE FlU: NUMIII:H
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
~
FROM THE BRIDE
1 L A. FULL NAME Kimberly Nora Hanford
FIRST MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENTAvazian
C. SURNAME AFTER MARRIAGE 8accomo
(OPTIONAL. SEE REVERSEh,S6-46-7420
o SOCIAL SECURITY NUMBER U
12. RESIDENCE ANew York B Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFyWappingers Falls
D. STRm ADDREss14 Clinton street
CURRENT SURNAME
ZIP 12590
"'0 YES 0 NO
1966
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE39 13.B. DATE OF BIRTH OS 12
MONTH DAY
14. EMPLOYMENT
A USUAL OCCUPATION Teachina Assistant
8. TYPE OF INDUSTRY OR BUSINESS Wappinger Cntrl. Shl. Dist.
15. PLACE OF BIRTHPouahkeepsie, New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME John Francis Avazian
B. COUNTRY OF BIRTM 5 A
17. MOTHER
A. MAIDEN NAME Margaret Regina Me Carthy
8. COUNTRY OF BIRT~ S A
18. NUMBER OF THIS MARRIAGE 2
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19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) d' DIVORCE (3) 0 ANNULMENT @,) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 10 / 24 /20U2
MONTIilf DAY YEAR
D. ARE ANY FORMER SPOUSEIS) ALIVE? [j 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
1ST 10/24/2002 Pouahkeepsie. New York r!f
DEATH
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2ND
3RD
TIME
MONTH
YEAR
MONTH
YEAR
ZIP
AM
04 :09 PM
22 2006
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
1ft.. CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY RrnJ/h17
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TITLE . 'JJ!J/?Jfi?/? v)lt)tjV./J'17eE
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ,,,,''is TOWN OF 0 VILLAGE OF
SPECIFY PHIWt:.(fTOt..J)IJ
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Mus IV?I /;.<s< ()
ZIP
31 WITNESS TO CERE~NY Il ^ I
NAME (PRINT) 1< iJREAJ I1tJ DE!2,.S3{j/v
SIGNATURE~ .Ka--z:R~ ~.~.",
STATE