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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
1!11 0 1 ST 06I06f1_ Brooklyn, ~"J York 0 r!J'
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
knowledge and belief that the information I provided ;z.d that I declare that no legal Impediment eXists
22 SIGNATURE OF BRIDE ~ 'l41--....J'.JL z~~v.:.
. USE CURR E
23 ~~J,f-n:~~Do~~~~Ot: 6'ivB D /' Mm5I'2OO~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to pertorm marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is tD be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
COUNTY Dutcbsr
CITYfTOWN \Napplnger
~~J~~~T 1368
~5~I~J~R 66
1. A. FULL NAME
JDlIMRh A. SawBNT SURNAME
FIRST
"-
N
B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 052-56-8136
2. RESIDENCE A. N (~ATE) B. ~
C. CHECK ONE 0 CITY ., TOWN 0 VILLAGE
ANO Wa .
SPECIFY ppnger
D. STREET ADDRESS 51 Alpert Drtve ZIP 125AO
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES it NO
Mo1~ /~ /1~
3. A. AGE 44
4. EMPLOYMENT
A. USUAL OCCUPATION SUpervisor - Plumber
B. TYPE OF INDUSTRY OR BUSINESS I II 11th & Hasp Corp
5. PLACE OF BIRTH ~~ ~X.
. 1>fr I USA)
6. FATHER
38. DATE OF BIRTH
A. NAME Anthony Saiwone
8. COUNTRY OF BIRTH II S A
7. MOTHER
A. MAIDEN NAME Ann Hlln
8. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
100
B. HOW DID LAST MARRIAGE END? (3) lY'DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 10 / m / ?IV11
MONTH Dr ~
D. ARE ANY FORMER SPOUSE(S) ALIVE? [YIfES 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
10102fJ001 YJhtte PI..., NatJ York
21. SIGNATURE OF GROOM ~
W
C/)
z
W
()
::i
~
{ SEAL }
'-,,-/
NAME (PRINT)
SIGNATURE ~
DOH-9B (1 1/9B)
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. FULL NAME FIRST Fra!MP Augu~i!WENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Auguglillro
c. SURNAME AFTER MARRIAGE ~one
(OPTIONAL - SEE REVERS~
D. SOCIAL SECURITY NUMBER 12&-44 3564
12. RESIDENCE A. N 'tTATEI B. ~
C. CHECK ONE 0 CITY [jjjII TOWN 0 VILLAGE
AND Wa .
SPECIFY ppnger
D. STREET ADDRESS 5 tAl pA't DrIve ZIP 125M
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES !it NO
~H /~y ,(~
13. A. AGE -49
13.8. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION BiDing Clf!iT
B. TYPE OF INDUSTRY OR BUSINESS Perforn\ence MotH Cers
15. PLACE OF BIRTH Rrt'lftltlvn NAIl V tvIr
~N~~
16. FATHER
A. NAME Frank Augugliaro
B. COUNTRY OF BIRTH I J S A
17. MOTHER
A. MAIDEN NAME ROIemarte MardllCII
B. COUNTRY OF BIRTH USA
1B. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
100
B. HOW DID LAST MARRIAGE END? (3) cY'olVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 06 / M /1QRA
MONTH ~ y~
D. ARE ANY FORMER SPOUSE(S) ALIVE? [)fifES 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
TIME
MONTH
YEAR
MONTH
YEAR
06
08
04 2003
06
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COU~
C. LOCATION OF CEREMONY
(CHECK ONE AND ECIFY)
NAME (PRINT)
SIGNATURE ~ ·