099
+
I-
Z
LLl
III
LLl
In
o
...J
=>
o
r
III
Z
o
;::
..
rr
I-
III
a
LLl
rr
LLl
Cl
..
CI:
rr
..
::!
u.
o
LLl
I-
..
()
ii:
;::
rr
LLl
()
LLl
rr
LLl
r
;:
III
III
LLl
rr
o
o
..
>-
u.
13
LLl
"-
III
w
en
z
w
0
::i
+
Z' .
rr~5 W
~;:~ ~
~~-
I-LLlZ
Ul..J::! 0
=>()LLl
::!Cl5 u::
I-ZUl i=
Z-
~~~ ~
8:0(1) W
01->- 0
..w~
~~Lt)
OW
zgl!;
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
R~nd~1 Ch~rles Colden
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinqer
~~~~~~ 1368 .
~5~li~~R 99
1 . A. FULL NAME
FIRST
"-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 067 -78-5581
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W '
SPECIFY applnger
D. STREET ADDRESS 19 White Gate Dr: Apt J ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
3. A. AGE 20 3B. DATE OF BIRTH On / '5 / 1990
MONTH DAY YEAR
w
S
4. EMPLOYMENT
A. USUAL OCCUPATION C~shier
B. TYPE OF INDUSTRY OR BUSINESS Price Chopper Grocery
5. PLACE OF BIRTH Pouahkeeosie. Nv
(CITY, S+~TE / COUNTRY IF NOT USA)
6. FATHER
A. NAME R~ymond Robinson
B. COUNTRY OF BIRTH Unknown
7. MOTHER
A. MAIDEN NAME Renee Lynn Colden
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
- ~
:>
CI:
- C
u::
LL.
CI:
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
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) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Yi
I
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Joy Elizabeth Venettozzi
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Colde n
(OPTIONAL - SEE REVERSE) 105 76 0419
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 19 White Gate Dr; Apt J ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r;1 NO
10 /09 /1989
MONTH DAY YEAR
13. A. AGE 20
13B.DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Hostess
B. TYPE OF INDUSTRY OR BUSINESS Red Robin
15. PLACE OF BIRTH New Hartford. Ny
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Richard Fred Venettozzi
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Suzanne Christine Robinson
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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
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
(MONTH, DAY, YEAR) (CITY/COUNTY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
o
o
o
1ST
2ND
3RD
o 0
o 0
o 0
o 0
I impediment exists
a:
w
In
::!
=>
Z
o
Z
..
I-
W
W
a:
I-
Ul
USE CUR
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
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 !l11 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) Joh
{TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ DATE 08/05/201
\....-. -.J MAIL~~ 1\Pl1IRF~~eb 11 1 ().M 08 06 2010 10 04 2010
-v- LU MICCII Rd, Wappingers Falls, NY 12590 :
STREET CITYITOWN STATE ZIP PM
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 ~ RELIGIOUS
DATE AND AT THE TIME AND 1 I I q II
PLACE INDICATED. I c.Jo M t) 11 I () 90 OTHER. SPECIFY
29. OFFICIANT \) ~. I \ I rJ . A Y, . I r
NAME (PRINT) I L!:C v, ... 0 ff IV', I 0 t.I f'J '" TITLE
SIGNATURE~ '1)1/ ~ .III' \l~ DATE
MAILING ADDRES~ ~ , /' L)
ll/OC lCT ':;-2 ':'5f-l~/Li..
STREET CITYfTOWN
30. WITNESS TO CEREMONY
1ST
2ND
3RD
NAME (PRINT)
SIGNATURE~
DOH-98 (09/2009)
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY '\)Vfl. H [ '> (
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF li:1 TOWN OF 0 VILLAGE OF
SPECIFY 1=='\ ((~ It ILL
NAME (PRINT)
SIGNATURE~