013
0..
N
+
o~
CJ)t;
Lt)
N
......
>-
!zZ
w
en
w
III
g
=>
o
:r
en
z
o
~.
t;;
a
w
a:
w
~
it
a:
<
::;
u.
o
~
o
u:
~
w
o
w
a:
w
~
en
en
w
a:
o
~
~
@
0..
en
0:'
W
~
=>
Z
Q
:l
Iii
w
~
+
~~z w
t~~
a:";S ~
t;;~~ 0
=>ow
::EClcj u:
!z~en
~~15 ~
!toen W
~~~ 0
I!!~",
o~
z::;~
COUNTY Dutchess
CITYfTOW~ Wappmger
D1STRICT1368 '
NUMBER
REGISTER 1 3
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDA Vir, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christopher Michael Pagano
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
Lo
SUPPLEMENTAL FILE
FROM THE BRIDE
Melanie Anne Frye
.J
1. A. FULL NAME
11. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSED 57 -72-6936
D. SOCIAL SECURITY NUMBER
2. RESIDENCEA. NY B. Ulster
(STATE).L (COUNTY)
C. CHECK ONE [j CITY'Ll TOWN 0 VILLAGE
~~CIFY PlatteKiII
D. STREET ADDRESS 13 Sollazzo Lane
B. BIRTH NAME (MAIDEN NAME)}!) DIFFERENT
C. SURNAME AFTER MARRIAGE agano
(OPTIONAL - SEE REVERSE1I27 -68- fl::l4L
D. SOCIAL S~~TY NUMBER Dutchess
12. RESIDENCE A. B.
(STATE) >I (COUNTY)
C. CHECK QI'j,E, 0 CITY [;l. T,OWN 0 VILLAGE
AND vvappmgers railS
SPECIFY 7 A Hi tl 5t 12590
D. STREET ADDRESS g '!7
E. IS RE~~NCE WITHIN LIMITS OF CITY OR INCORPORACfl VILLAGE~a 0
13. A. AGe': 3B. DATE OF BIRTH ~
MONTH DAY
14. EMPLOYMENT f' I M k Art' t
Pro esslona a eup IS
A. USUAL OCCUPATION Cosmetics
B. TYPE OF INDIJ.!lTRY OR !'l.USINESS N
15. PLACE OF BIRTHt"ougnKeepsle, Y
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER J ff D I F
A NAME e rey a e rye
. USA
B. COUNTRY OF BIRTH
ZIP
lL::>2l:S
>I
YES Q NO
/1981
YEAR
Y~10
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
11 /26
DAY
3. A. AGE 28
3B. DATE OF BiRTH
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION HVAC Tech
B. TYPE OF INDUSTRY OR BUSINESN HV AC
5. PLACE OF BIRTH Newburgh, y
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Frank paaano
B. COUNTRY OF BIRTH S A
7. MOTHER
A. MAIDEN NAME Debra Ann Denton
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
17. MOTHER
Elizabeth Ruth Hlavacek
A. MAIDEN NAME LJ S A
B. COUNTRY OF BIRTH 3
18. NUMBER OF THIS MARRIAGE
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A'lrULMENT
.,
B. HOW DID LAST MARRIAGE END? (3) 0 DIVO'ljS (3) CO~NULMENT 2o~91 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONT" DAY' . - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
l/rIQIiJti6D~OY~I\fl) P (CITY/p_ql!NTY. STA1E/COIi~RY. IF NOT USA) SELF SPO~E
ST Ul:1ILI IL UO ougnKeepsle, I'IY n. 0
o 0 1 08/06/2009 Poughkeepsie, Ny v
o 0 2ND 0 0
~../--------~~ :;~ ~
~~~Ii8f-1hf1t-the1nformation-l1' diment Bxists
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
D~TH
DttTH
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
YEAR
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and ~'II_ ha
as to my right to enter into the mar age
21. SIGNATURE OF GROOM~
23. SUBSCRIBED AND SWORN TO/AF IRMED
SIGNATURE OF TOWN OR CITY C ERK~ DATE
This license authorizes the arria in Ne York State of the bride and groom named above by any person authorized by New York Domestic
W RelBtlons Law ~11 to perform mar e ceremon~s within New York State. THIS LICENSE VALID IN NEW YORK STATE ONL. Y.
en 0 If checked, this/license is to be used onl for the purpose of a second or subsequent ceremony.
Z -^- 24. TOWN OR CITY CI-ERK 25 A SOLEMNIZATION PERIOD BEGINS 25. B. SOLEMNIZATION PERIOD
W r- ~ Jonn C Masterson . . ENDS AT MIDNIGHT ON:
o { } NAME (PRINT) .
::J SEAL SIGNATURE ~ ; _ DATE 03/05/201 0 TIME MONTH YEAR MONTH YEAR
'-.,-I MAI~~Mrd'8f~b sh Rd, Wappingers Falls, NY 12590 02:48~~ 03 06 2010 05 04 2010
STREET CITYITOWN STATE ZIP
~~~~~RTr~J IO~O~~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M AY YEAR 0 0 RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
1tpi. CIVIL
A. STATE NEW YORK B. COUNTY l-t l-S'(cr
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY t-{....(J Vi)
29. OFFICIAN r
NAME (PRINT)
r-
,;:..:r;
( N u.sTh-r
S _Of. .;J.-d/ 0
yr~
31. WITNESS TO
NAME (PRINT)
SIGNATURE~
nnu no Inl'J nnnD\