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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c~ 1368 .
~~~li;~R 105
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
M~!aert ArOibC!MmENTSURNAME
I
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Patricia A Kanaras
MIDDLE CURRENT SURNAME
~
1. A. FUll NAME
11. A. FULL NAME
FIRST
FIRST
0.
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE K::ln::!r::)!=:-Argihay
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 129-56-4049
12. RESIDENCE A. NY B. nlJtchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r!t TOWN 0 VILLAGE
~~~CIFY Fishkill
D. STREET ADDRESS 81 Town View Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
/01 A9nO
DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 11 2 -5n-3623
2. RESIDENCE A. N~ B. ?cllt~F!!=:S
( TATE) COUN )
C. CHECK ONE 0 CITY it! TOWN 0 VILLAGE
~~~CIFY Fi!=:hkill
D. STREET ADDRESS 81 Town View Drive
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r!'f NO
MOJ] / Dla / yl~65
13B.DATE OF BIRTH
03
MONTH
13. A. AGE !=in
3. A. AGE 44
3B. DATE OF BIRTH
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4. EMPLOYMENT
A. USUAL OCCUPATION Stcte r.nrrF!~tien!=: nffi~F!r
B. TYPE OF INDUSTRY OR BUSINESS NYS DOCS
5. PLACE OF BIRTH Manhattan NY
(CITY, STATE / COUN~RY IF NOT USA)
6. FATHER
A. NAME Aide Aroibay
B. COUNTRY OF BIRTH Cuba
7. MOTHER
A. MAIDEN NAME Flvira Gnn7alez
B. COUNTRY OF BIRTH Cllha
8. NUMBER OF THIS MARRIAGE 2
14. EMPLOYMENT
A. USUAL OCCUPATION Medical Secretary
B. TYPE OF INDUSTRY OR BUSINESS Medical
15. PLACE OF BIRTH Pouahkeeosie. NY
(CITY, S'n.TE / COU~RY IF NOT USA)
16. FATHER
A. NAME GlJS Kanaras
'B. COUNTRY OF BIRTH Greece
17. MOTHER
A. MAIDEN NAME Nickie Lines
B. COUNTRY OF BIRTH Greece
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) c(DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? on/ 12 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 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 USAI SELF SPOUSE
06/12/2002 Orange County. Ny
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) dDIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 06 / 04 / 1991
MONTH DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? [(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
06/04/1991 Dutchess County. Ny
DEATH
o
DEATH
o
(2) 0 DEATH
2002
YEAR
rI
if 0
o 0
o 0
o 0
d that I declare that no legal impediment exists
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1ST
o 2ND
o 3RD
o 4TH
(j belief that the information I provided is true
OL-
21. SIGNATURE OF GROOM~
22. SIGNATURE OF BRIDE~
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USE CU
23. SU8SCRIBED AND SWORN TO/AFFIRMED 8EFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New Y k
Relations Law !l11 to perform marriage ceremonies n ork 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) Jo
{ ~ ~ ~
SEAL SIGNATURE ~
'-v-' MAI28 Mid~~ AM 08 14 2010
STREET 03:03>M
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
10
12 2010
DATE 08/13/2010
by New York Domestic
MONTH
YEAR
1~VIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY trtC[ e 5'
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LLAGE OF
() SPECIFY tJ A/hp be f 5" fA [( :3
NAME (PRINT)
SIGNATURE~