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CITYfTOWN vvapplnger
DISTRICT1368 '
NUMBER
REGISTER 132
NUMBER
__I , U 'I .'W,_I" I '-', . .....,-,.... I I I
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Lawrence Joseph Reina, JR.
MIDDLE CURRENT SURNAME
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Borbala Baksa
-.J
1 . A. FULL NAME
1 1. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
0-
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE>137 -56-1797
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE).L. (COUNTY)
C. CHECK ONE Q CITY 'U TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D. STREET ADDRESS 30 Swenson LJrlve ZIP 1 Lb90
>l
E. IS RESIDENCE WITHIN LIMITS Of CITY OR INCORPORATED VILLAGE? 0 YES 0 NO
3. A. AGE 51 3B. DATE OF BIRTH 06 /01 /1958
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Home Improvement Contractor
B. TYPE OF INDUSTRY OR BUSINESS Contracting
5. PLACE OF BIRTH Elizabeth, NJ
14. EMPLOYMENT N
anny
A. USUAL OCCUPATION Child Care
B. TYPE OF INDlJliiTR)J OR BUSJ.NE.Sfl
~uuapesl nungary
15. PLACE OF BIRTH I
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER Att'l Baksa
A NAME la
, . . Hunga~
B. COUNTRY OF BIRTH
(CITY, STATE I COUNTRY IF NOT USA)
~
:>
c(
c
wi!
"u.
-c(
6. FATHER
A. NAME Lawrence Joseph Reina Sr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Patricia Josephine Kuzma
B. COUNTRY OF BIRTH USA
e. NUMBER OF THIS MARRIAGE 2
le. NUMBER OF THIS MARRIAGE
17. MOTHER
Borbala Csaszar
A. MAIDEN NAME H
unga~
B. COUNTRY OF BIRTH 1
W
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9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) r5 DIVORCE (3) 0 AN~LMENT 2~8fEATH
C. DATE LAST MARRIAGI{ENDED? 02 / 1 /
MONTfLI DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? [j YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEA~ (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 02/15/200 { Poughkeepsie, Ny r5
2ND
3RD
4TH
I duly swear/affinn, depose and sa
as to my right to enter into the
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A~ULMENT
DijTH
DeeTH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.'- YEAR
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) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 0 0
~D 0 0
~D 0 0
~ 0 0
lief that the infonnation I provided is true and that I declare that no legal impediment exists
~ ---- ~
USE CURRENT NAME 11/16/2009--
DATE
21. SIGNATURE OF GROO
23. SUBSCRIBED AND S /OR
SIGNATURE OF T N CITY CLERK ~
This license aut zes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law !l11.to perfonn 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 C ERK 25. A. SOLEMNIZATION PERIOD BEGINS
n
by New York Domestic
,-A-..
{ SEAL }
'-v-I
YEAR
MONTH
YEAR
TIME
MONTH
AM
03:01 PM
11
17
2009 01
ZIP
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
CITYITOWN
26. SOLEMNIZATION OCCURRED
TIME MO. AY YEAR
11: 35~~ 11/20/2009
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
2B. PLACE WHERE MARRIAGE OCCURRED
1 KI CIVIL
A. STATE NEW YORK B. cou~utchess
c. LOCATION OF CEREMONY
.(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY Poughkeepsie
29. OFFICIANT 11
NAME (PRINT) Susan J. Mi er
".","'"". h I rOv'\\ ~ - Y'{\ ,n Q OJ\)
MAILING ADDRESS ~ \"
1 Overocker Road. Pou~hkeepsie. New
STREET CITY/TO N
30. WITNESS TO CE~MONY
NAME (PRINT) l' L It~
SIGNATURE~
OOH-98 (03/2006)
TITLE
Marriage Officer
11/20/2009
DATE
York. 12603
STATE
,
IcecCs,
SIGNATURE~