043
]
lj)
N
T"""
-""
....
f"
--
$:
CD w
z 2
Ul
~
m
lJ...
(I)
~~ I-
*0) :>
we <(
~ C
~g. ~ u:
~~LL
? ~ <(
g...:~
rg
f- . >-
~0
~
~CD
~
::;0
m::
~
~
~
w
U
w
a:
w
I
~
Ul
CfJ
w
a:
o
o
'"
C;:
o
w
"-
CfJ
z z
~ 3 w
1i' ;:j l-
f- Z <(
"5 aJ U
~ g u:
~ u- i=
8 0 a:
o ~ w
w 0 U
I- "'
o
z '"
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM_THE GROOM
Mlcflael E.~ughes
B HOW DID LAST MARRIAGE END? (3) 0 DIVO'lJ1 (3) CJrNULMENT19~ DEATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVO~c.r /(3) ~ ~NULM/ENT19~~ DEATH
C DATE LAST MARRIAGE ENDED? MON1'I / DAY / YEAR C. DATE LAST MARRIAGE ENDED? MON,""" - DAY - YEAR
o ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO 0 ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10 IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
1ST df~~fi9s:t~o~ghl(eeps~e~NewTfc)lrk S~F SPO~E 1ST 11fi~f{9~~o\jgh~eeps~e~Ne;TfoHt S~F SPO~E
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 [J
4TH 0 0 4TH 0 D
I, being duly sworn, depose and say, that to the st of my knowledge and belief that the information I provided is true that I declare that noJegal impediment exists
as to my right to enter into the marriage sta . " /1()U Ilt _ /\ , ""
21 SIGNATURE OF GROOM ~ ~ I "--Ct. \/' ~
23 SUBSCRIBED AND SWORN TO BEFORE ME USE CURRENT NAME 04/26/2002
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York St e of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies withi ew York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked. this license is t be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CC;18IfliKJ. Morse 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) ,
Dutchess
COUNTY W .
uppulyt:r
CIWTOW"68
DISTRICT I,)
~~~1~~~~3
NUMBER
A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
"-
N
8 BIRTH NAME. IF DIFFERENT
C s~~~~~J::LTE~~:~~e~~srl]85-62 -98 15
D SOCIAL SEr;re\~r~~fk Dutcness
2 RESIDENCE A. (STATE) ..I (COUNTY)
C ~H6CK orwappm~er 0 TOWN 0 VILLAGE
SPECIFY 1668 Roul~ 9 A I. 1 F 12596
D STREET ADDRESS P ZIP
v
E IS R~~NCE WITHiN LIMITS OF CITY OR INCORPORATEi()VSLAGE?)I' 1 0 YES !h~~
3 A AGE 3B. DATE OF BIRTH - ~
MONTH DAY YEAR
4. EMPLOYMENT
Gas Mechanic
A USUAL OCCUPATION ShaUll 5. Kalba Enl~fpfi~~::;
B. TYPE OF IND~TRY .Qil.i~SINE~t N .. rk:
5. PLACE OF BIRTH oUYII ep e, ew TO
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER R d H h
aymon ug es
A NAME USA
B COUNTRY OF BIRTH
7. MOTHER
Barbara Me Kenna
A MAIDEN NAME USA
B COUNTRY OF BIRTH 2
8 NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV~RCE CIVIL A~ULMENT
D'ttTH
-.
ffi
CD
"
OJ
Z
o
z
<(
>-
w
w
go
Ul
w
en
z
w
U
:J
~
{ SEAL }
"-y-/
CITY,'TOWN
26. SOLEMNIZATION OCCURRED
TIME MO DAY YEAR
STATE
27. TYPE OF CEREMONY
0'tJ RELIGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTyW1C t\E: ss
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
c::; CITY OF C TOWN OF I>C VILLAGE OF
SPECIFY \,\lny?;(y( ,". \(\ \ \s
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER~
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
\ \
o
5
~~~t~~~~~T "Ke"l. s'\xs~c(\ L. ~~\\ \i(\,-",~
SIGNATURE ~ V ..(.\) 7~/"'-~ ."l)( .l ( \..lt~- =-OATE
MAILlI)IG ADDRESS -L--1
ElmS!. t ')Gv1~ Y\...f. \Al(,")-?~'-<"f('S '\7,l\.)
STREET CITY TOWN' \
30 WITNESS TO CEREMONY
/l
NAME (PRINT) C-o,e...Cj
~ ((/
TITLE
SIGNATURE ~
DOH-9B (11/98)
IJ;C1 ~J >
J
::'1 P4.11:. riLl:: l'\IUMC~n
(THIS SPACE FOR STATE USE ONL Y)
~l
S ~/8'- ti.~
L D SUPPLEMENTAL FILE
FROM TlHE BBIDE
Isa Manano
--.J
11 A. FULL NAME
FIRST
MIDOLE
CURRENT SURNAME
8 BIRTH NAME (MAIDEN NAME)'fEf(fgf1~~
C S~~~~~JN~~E~~:~e~~SE) 130-40-8531
D SOCIAL SIiC~RITY NlJ~B"lL 0' ~ t..
NeW T Of]( UIClless
12 RESIDENCE A. (STATE)~ B. (COUNTY)
C. ~H6CK \tappfnd'ir 0 TOWN 0 VILLAGE
SPECIFY 1668 Ruul~ 9 A l. 1 F
D STREET ADDRESS P
....
E IS RE~~NCE WITHIN LIMITS OF CITY OR INCORPORAT<t)jLLAGE? 70 0
13. A AGE 13.B. DATE OF BIRTH L
MONTH DAY
14. EMPLOYMENT Dental Office Manager
A. USUAL OCCUPATION 51\::V~fl J. BI\::i
B TYPE OF IND~r()'HSf. ~IJty ork
15. PLACE OF BIRTH '
(CITY. ST A TEiCOUNTRY IF NOT USA)
16 FATHER Michael Mariano
A NAME U 5 A
B COUNTRY OF BIRTH
17. MOTHER A P . t
nn anepln 0
A MAIDEN NAME USA
B. COUNTRY OF BIRTH 2
lB. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A~ULMENT
Yyi6(fO
YEAR
D'jfH
.....
TIME
MONTH
YEAR
MONTH
YEAR
ZIP
AM 04
1 :38 PM
2002 06
25 2002
27
STATE
31.
NAME (PRIN"T~
SIGNATURE ~