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Dutchess
Wappinger
1368
25
I STATE FILE NUMBER I
(THIS SPACE FOR STA TE USE ONL Y)
1\
~ . O~
~ S' \'
Lo SUPPLEMENTAL FILE ~
COUNTY
CITY,TOWN
DISTRICT
NUMBER
REGISTER
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael J Noonan 11 A FULL NAME
MIDDLE CURRENT SURNAME
FIRST
FROM THE BRIDE
Denise Marie Martucci
MIDDLE CURRENT SURNAME
A FULL NAME
FIRST
B BIRTH NAME. IF DIFFERENT
BIRTH NAME (MAIDEN NAME) IF DIFFERENT
C SURNAME AFTER MARRIAGE Noonan
(OPTIONAL. SEE REVERSE) 066 70 4238
D SOCIAL SECURITY NUMBER --
12 RESIDENCE A Connecticut B Fairfield
C CHECK ONE (STADE) CITY 0 "'OWN 0 VILLAGE (COUNTY)
~~~CIFY Brookfield
D STREET ADDRESS 7 Tara Drive
06804
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 137 68 3762
o SOCIAL SECURITY NUMBER --
2 RESIDENCE A Connecticut B Fairfield
C CHECK ONE (STADEl CITY D"TOWN 0 VILLAGE (COUNTY)
~~~CIFY Brookfield
o STREET ADDRESS 7 Tara Drive
06804
ZIP
ZIP
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE' 0 YES D""NO
13. A. AGE :11 13.B.DATEOFBIRTH 01 / 13 /1971
MONTH DA Y YEAR
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE'
0:1 /
MONTH
DYES c:Y' NO
14 / 1 ~7
DAY YEAR
3 A AGE 32
3B. DATE OF BIRTH
4 EMPLOYMENT
14. EMPLOYMENT
A. USUAL OCCUPATION Sales Assistant
B. TYPE OF INDUSTRY OR BUSINESS Bailev & Beattv Financial
15. PLACE OF BIRTH Pouahkeeosie. New York
(CITY. S1'j(TE,COUNIRY IF NOT USA)
16 FATHER
A. NAME Richard Martucci
B. COUNTRY OF BIRTH USA
A USUAL OCCUPATION Tech Support
B TYPE OF INDUSTRY OR BUSINESS Ibm Corp
5. PLACE OF BIRTH Everett Massachusetts
(CITY. STATE/c;OUNTRY IF NOT USA)
6. FATHER
A. NAME William Noonan
B COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME lacq"Plinp pp::lr!':nn
B COUNTRY OF BIRTH l J S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
17 MOTHER
A. MAIDEN NAME Filppn Rrp!=ilin
B. COUNTRY OF BIRTH USA
18 NUMBER OF THIS MARRIAGE 1
19 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
o
o
B. HOW DID LAST MARRIAGE END' {3} 0 DIVORCE
C DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
12} 0 DEATH
B. HOW DID LAST MARRIAGE END? 13} C DIVORCE
C DATE LAST MARRIAGE ENDED?
13} 0 ANNULMENT
/ /
12} 0 DEATH
MONTH DA Y YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES :J NO
10 IF PREVIOUSLY DIVORCED OR ANNULED PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEAR) ICITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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
~
1 ST 0 0 1 ST 0 0
2ND n 0 2ND 0 C
3RD C 0 3RD 0 n
4TH 0 0 4TH C 0
I. being duly sworn, depose and say. that to the best of my knowledge and belief that the information I provided is tru~nd that I ~eClare that no legal impediment exists
as to my right to enter into the marriage state. ~ - /Y)/ _ ..L
21 SIGNATURE OF GROOM ~. 2 SIGNATU E OF BRIDE ~ /Ya.1--GI / /I..d-vf'<<L.t'<-
USE CURRENT NAME
z
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or
DATE
03/15/2002
w
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Z
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23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride d groom named above by any person authorized
Relations Law Sll 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
by New York Domestic
NAME (PRINT)
TIME
MONTH
~
{ SEAL }
"-v-I
11 : 13M
PM
03
16
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMEO ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
28 PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTy-;j)IATGJf&Sd
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~N OF 0 VILLAGE OF
SPECIFY 1hW.6}1-ft:..'S<i t'~ ,.~
NAME (PRINT)
SIGNATURE ~