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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Mariano Hernan Choconi
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN. Wappinger
~~J~~c: 1368
~5~~~R 12
1. A. FUll NAME
ARST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2: RESIDENCE A. New York
(STATE)
C. CHECK ONE 0 CITY ~TOWN
~~CIFY Wappinger
D. STREETADDRESS 2 Bungalow Lane ZIP 12590
E. IS RESIDENCE WITHIN UMITS of CITY OR INCORPORATED VIlLAGE? 0 YES rI NO
3. A. AGE 27 3B. DATE OF BIRTH 09 / n6 / 1Q77
MONTH DAY YEAR
B. Dutchess
(COUNTY)
o VILLAGE
4. EMPLOYMENT
A. USUAL OCCUPATION student
B. TYPE OF INDUSTRY OR BUSINESS Academy Of Massage
5. PLACE OF BIRTH Buenos Aires. AraenUna
(CITY, STATEICOUNTRY IF NOT U!A)
6. FATHER
A. NAME Jose Bernardo Choconi
B. COUNTRY OF BIRTH ArQentlna
7. MOTHER
A. MAIDEN NAME Marla Crl~na VA"qJl~
B. COUNTRY OF BIRTH Argentina
8. NUMBER OF THIS MARRIAGE 1
9. 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) D DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Nancv Cecilia Cocca
MIDDLE CURRENT SURNAME
~
11. A. FUll NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Choconi
(OPTIONAL. SEE REVERSE) 1 n. aD -5~4
D. SOCIAL SECURITY NUMBER \rt'"UU" ~'
12. RESIDENCE A. New York B. Dutchess
(ST A TEl (COUNTY)
C. CHECK ONE D CITY ~OWN D VILLAGE
AND Wa .
SPECIFY DPInaer
D. STREET ADDRESS 2 !3unaalow Lane ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES rI NO
n7 /10 /1978
MONTH DAY YEAR
13. A. AGE ?6
13.B.'DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Coordnator
B. TYPE OF INDUSTRY OR BUSINESS Maqt's Dept. Store
15. PLACE OF BIRTH Buenos Aires. AraentJna
(CITY. STATE/COUNTRY IF NOT U~)
16. FATHER
A. NAME Juan Cocca
B. COUNTRY OF BIRTH Argentina
17. MOTHER
A. MAIDEN NAME SIMt' r:tlanM
B. COUNTRY OF BIRTH Argentina
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) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) D ANNULMENT
/ /
(2) D DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE{S) ALIVE? DYES D 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
2ND
3RD
4TH
I, being duly sworn, depose and
as to my riglrt to enter into the m rri
21. SIGNATURE OF GROOM ~
D 1ST
D 2ND
D 3RD
D 4TH
nd belief that the information I provided is true an
D D
D D
D D
D D
at no legal impediment exists
23. ~~~~~=~O~.f~ci~B~~~ DATE 02I18f2D05
This license authorizes the marriage in New York Stat of the and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within W 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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{ SEAL }
'-v-'
NAME (PRINT)
NAME (PRINT)
SIGNATURE ~ ·
OOH-98 (11/98)
2. SIGNATURE OF BRIDE ~
TIME
MONTH
YEAR
MONTH
YEAR
AM
ZIP 02:1S'M
l~IL
02
19
04
19 2005
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY~dJ'e;JkJ!.
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /'
D CITY OF D TOWN OF ~LLAGE OF
SPECIFY W~/~2JC& ~
NAME (PRINT)
SIGNATURE ~