090
"-
N
+
f-
Z
W
rtJ
W
<II
Cl
...J
::>
o
I
rtJ
Z
o
>=
..
a:
ti;
a
w
a:
w
Cl
..
CI:
a:
..
::!
u.
o
w
>-
..
(J
u:
~
w
(J
w
a:
w
I
;=
rtJ
rtJ
W
a:
Cl
Cl
..
it
C3
W
0-
rtJ
a:
w
III
~
::J
Z
"
Z
..
I;;
w
a:
>-
Ul
+
~~~
t;j;=>-
a:"";S
~~~
:)c,,) w
::!Cl5
>-ZrtJ
z-
~~~
~O(l)
0>->-
..UJ ~
~~"'
o~
Z:J~
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:kc: 1 368 .
~~~I~J~R 90
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Vincent John DeCicco
MIDDLE CURRENT SURNAME
I
STATE FilE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
~
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Cynthia Vasquez
MIDDLE CURRENT SURNAME
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
B. BIRTH NAME. IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE DeCicco
(OPTIONAL - SEE REVERSE)1 07 -66-3656
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANY BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESs308 Sterling Dr
ZIP 12b9U
DYES 1] NO
~77
YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 092-66-4204
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VilLAGE
AND W .
SPECIFY appmger
D. STREET ADDRESS 308 Sterling Dr ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES It'] NO
01 /01 /1978
MONTH DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 32 13B.DATE OF BIRTH 12 ~8
MONTH DAY
3. A. AGE 32
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Automation Specialist
B. TYPE OF INDUSTRY OR BUSINESS Government
5. PLACE OF BIRTH San Gill Colombia
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME John Vincent DeCicco
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Judith Carole Galiotto
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
14. EMPLOYMENT
A. USUAL OCCUPATION House Wife
B. TYPE OF INDUSTRY OR BUSINESS House Wife
15. PLACE OF BIRTH Manhattan, NY
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Ferdinand Vasquez
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Evelyn Fuentes
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 05/ 19 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 0 NO
DEATH
o
(2) 0 DEATH
2009 .
YEAR
10. IF PREVIOUSLY DIVORCED OR ANNULLED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY/COUNTY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
05/19/2009 Poughkeepsie, NY r$
21. SIGNATURE OF GROOM~
w
CJ)
Z
W
o
:J
23. SUBSCRIBED AND SWORN TO/AFFIRMED
SIGNATURE OF TOWN OR CITY CLERK ~
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 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
} NAME (PRINT) John C. Maste son
{SEAL SIGNATURE ~ t. . DATE 07/26/201 YEAR MONTH
"-v-I MAI~t&d'afe sh Rd, Wappingers Falls, NY 12590 2010 09 24 2010
STREET CITYITOWN STATE ZIP
~~~R~~~RT~~J lo~O~~~N~Zi~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR o~ RELIGIOUS
DATE AND AT THE TIME AND lL
PLACE INDICATED':T 0 9 0 OTHER. SPECIFY
~()f'F TITlEJ2/6tIr ~&aw
~. q. /0
2L/-O
YEAR
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYf)lfTCIfE>?
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF )c(TOWN OF 0 VILLAGE OF
SPECIFYEl1(i FI ~H~JLL
W
l-
ce
o
u:::
i=
ct
w
o
29. OFFICIANT
NAME (PRINT)
STREET
30. WITNESS TO CEREMONY,
NAME (PRINT)
(}