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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
.ln~e6lroL~ir.h~rd P2G~R~JTasuRNAME
USE CU
23. SUBSCRIBED AND SWORN T FFIRMED 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 ~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) Joh - .
{ 07/08/2009 TIME MONTH YEAR MONTH
SEAL SIGNATURE ~
'-- -J MAIJ.!~G,t\~Plj~eS Y 12590 AM 07 09 2009 09 06 2009
-v- STRf~ IVI ual ZIP 03:32PM
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29.0FFICIANr0.f
NAME (PRINT)
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~c; 1368
~5~I~J~R 68
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)096 60 6122
D. SOCIAL SECURITY NUMBER ___ - _ _ -
2 RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY olJ TOWN 0 VILLAGE
AND W .
SPECIFY appmger
D. STREET ADDRESS 1668 Route 9 ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES'tJ NO
05 / 11 /1977
MONTH DAY YEAR
3. A. AGE ~?
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS John Jay Hioh School
5. PLACE OF BIRTH Bronx. Ny
(CITY, STATE / COUNTRY IF NOT USA)
6, FATHER
A. NAME Joseph Pedota Jr
B, COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Maryann Rizzuto
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
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
o 0
o 0
o 0
w
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::l
SIGNATURE~
DOH-98 (03/2006)
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Janiann Sierdzinski
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Pedota
(OPTIONAL - SEE REVERSE)160 54 5308
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE ANY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinoer
D. STREET ADDRESS 1668 Route 9
ZIP 12590
DYES '6 NO
)1"974
YEAR
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE34 3B. DATE OF BIRTH 08 ~8
MONTH DAY
14, EMPLOYMENT
A. USUAL OCCUPATION Title Processor
B, TYPE OF INDUSTRY OR BUSINESS Realestate
15. PLACE OF BIRTHSomerville, Nj
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME John J. Sierdzinski Sr.
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN N~ME Michele R. McKendry
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH
100
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C: DATE LAST MARRIAGE ENDED? 05 / 05 / 2006
MONT)U DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? l.J 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
1ST 05/05/2006 Pike County, t1
2ND 0
3RD 0
YEAR
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
STATE NEW YORK B. COU~~
LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ OF 0 VILLAGE OF
i:ifJI ch /(, Ii
F
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