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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Vincent Philip Colaneri
MIDDLE CURRENT SURNAME
USE
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
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.
r-"-.. 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) John C. Masterson
{ ~ ~ ~
SEAL SIGNATURE ~ DATE 10/08/201
"-- -.J MAII.lNG 6Q,OI'f\Es'se AM 10 09 2010
-yo- LU M COlE sh Rd, Wappingers Falls, NY 12590 02:50pM
STREET CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27;:E OF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 RELIGIOUS 10 CIVIL
DATE AND AT THE TIME AND
PLACE INDICATED. : to 9 0 OTHER, SPECIFY
29. OFFICIANT f..t;I. f~. RllfJ"~ Pe4,. ~lJ cAtlolb.,.ttJ 'I),I~
NAME (PRINT) TITLE
SIGNATURE ~ lW . i~ ~VJ"'l..1>u~ U DATE Od'~~ 1.l ').f>(D
MAILING ADDRESS 1R ~",.; cN~lt.J\a.Oii (J#. I5tl.fSW ....ttll4 'f"11
. ~ ~'L '~A~~~11.I.ti ~6'" ~ 2,).,0
STREET CITYfTOWN STATE ZIP
30. WITNESS TO CEREMONY 31. WITNESS TO CEREMONY
NAME (PRINT) 3' ,4, -1.,(') N c.. Ml\ le,( NAME (PRINT) E IQ~r"\~.
COUNTY Dutchess
CITYiTOWN WappinQer
~~~~~: 1368 .
~~~~i~R 141
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
D SOCIAL SECURITY NUMBER 600-64-9139
2. RESIDENCE A. NY B. Dutchess
(ST ATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFY Fishkill
D STREET ADDRESS 24 Villaae Park Dr.; Apt 2A ZIP 12524
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? ~ YES 0 NO
01 / 02 /1986
MONTH DAY YEAR
3. A. AGE I'A.
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Direct Care
B. TYPE OF INDUSTRY OR BUSINESS Social Services
5. PLACE OF BIRTH Middletown. New York
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Ronald P Colaneri
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Cheryl Ann Hendricks
B. COUNTRY OF BIRTH U S A
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
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21. SIGNATURE OF GROOM~
W
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STATE FILE NUMBER
(TH/S SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
StaceJ,o~lnn Rodr~~R~~~ SURNAME
~
11. A. FULL NAME
FIRST
13. A. AGE 23
12
MONTH
13B.DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Nanny
B. TYPE OF INDUSTRY OR BUSINESS Child care
15. PLACE OF BIRTH Bronx. New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Raul Edgaldo Rodriguez
'B. COUNTRY OF BIRTH Puerto Rico
17. MOTHER
A. MAIDEN NAME Jeanette Freytas
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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /.
MONTH 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
(MONTH, DAY, YEAR) (CITY/COUNTY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 1ST
o 2ND
o 3RD
o 4TH
elief that the information I provided is 1ru
o 0
o D
o 0
o 0
ediment exists
.".
MONTH
YEAR
12
07 2010
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ()01dt~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
D CITY OF 0 TOWN OF rt VILLAGE OF
l.D 'IlAtl'~'" Ll~
SPECIFY
SIGNATURE~