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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael Lee Sozzi
MIDDLE CURRENT SURNAME
23 ~~J~T~~~Do~Ni'o~O~~ ~'?vBg~~~~E DATE LP/11DnnS
This license authorizes the marriage in New York the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies wit 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 Dutchess
CITY!T;:;WN WSDPlnoer
~~~~~c; 1368
~5~~J~R 10
1. A. FULL NAME
FIRST
"-
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B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 07')72 5066
D. SOCIAL SECURITY NUMBER .;yo'
2 RESIDENCE A NY B Dutchess
(STAT!,) (COUNTY)
C. CHECK ONE ~ CITY 0 TOWN 0 VILLAGE
~~~CIFY Beacon
D STREET ADDRESS 53 Chiusano Drive ZIP 12508
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 1!1' NO
10 /07 /1971
MONTH DAY YEAR
3. A. AGE 33
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Field Service
B. TYPE OF INDUSTRY OR BUSINESS Tokyo Electron America
5. PLACE OF BIRTH Cortlandt.. New York
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Leo Primo Sf"37i
B. COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Peidoie Marianne Berczan
B. COUNTRY OF BIRTH USA
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 (3) 0 ANNULMENT
c. DATE LAST MARRIAGE ENDED? / /
(2) 0 DEATH
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
0:
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21. SIGNATURE OF GROOM ~
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{ SEAL }
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STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
B~I~d A F rah~~RENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Sn77i
(OPTIONAL - SEE REVERSE) 2 2 95 2
D SOCIAL SECURITY NUMBER 1 5-5. 3
12 RESIDENCE A. N Y B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~TOWN 0 VILLAGE
~~~CIFY poughkeepsie
D. STREET ADDRESS 803 Cooper Road ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
1/ /?g A~
MONTH DAY YEAR
13. A. AGE 3~
13.B. DATE OF BIRTH
14. EMPLOYMENT
A USUAL OCCUPATION labor Services Representative
B. TYPE OF INDUSTRY OR BUSINESS Nevi York State
15 PLACE OF BIRTH Manhattan. N8\N York
(CITY. STATEICOUN~RY IF NOT USA)
16. FATHER
A. NAME Eugene T Fraher
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Miehaei"n E Mahon
B. COUNTRY OF BIRTH lJ 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
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
1ST
2ND
3RD
o
o
o
22. SIGNATURE OF BRIDE
TIME
MONTH
NAME (PRINT)
SIGNATURE ~
MAILING At;>DRESS
AM
02:30 PM 02
12
04
12 2005
STATE
27. TYPE OF CEREMONY
o~ RELIGIOUS
9 0 OTHER, SPECIFY
TITLE ;)I!d~
DATE \fd. cJ-4.uJ..{)o5
-Hof'a<JEu...Ter. N.y.I?-5"33
STATE
CI
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
YEAR
MONTH
YEAR
ZIP
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTy~~Es..s
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF pt(TOWN OF 0 VILLAGE OF
SPECIFY EAST F ISH ~ILL11J. '(
/
10 CIVIL
NAME (PRINT)
SIGNATURE ~