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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:f: 1368
~5~~~~R 31
~ I A It: UI"" Nt:W YUH~
DEPARTMENT OF HEALTH
AFRDAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
John Henry Bergmann
MIDDLE CURRENT SURNAME
CURRENT SU RNAME
(THIS SPACE FOR STATE USE ONL Y)
.J
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Michele Marinelli
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST MIl/OLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Vitulli
C. SURNAME AFTER MARRIAGE Bergmann
(OPTIONAL. SEE REVERSEI132-44-4655
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A.NY B Dutchess
(STATE).L (COUNTY)
C. CHECK ONE 0 CITY U TOWN 0 VilLAGE
~~~CIFY Wappinger
D. STREET ADDRESs24 I::rvm Ur
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)122_36_7968
D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY'tJ TOWN 0 VILLAGE
~~~CIFY Wap~in.ger
D. STREET ADDRESS 24 Ervin Dr ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES1] NO
12 /24 /1946
DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIULAGE?
13. A. AGE 52 3B. DATE OF BIRTH 06 )t 1
12b~U
ZIP
DYES 1J NO
)'956
YEAR
3. A. AGE 62
3B. DATE OF BIRTH
MONTH
DAY
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Retired Teacher
B. TYPE OF INDUSTRY OR BUSINESS Education
5. PLACE OF BIRTH Bronx, NY
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Henry Joseph Bergmann
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Margaret J.oyce
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 2
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher Assistant
B. TYPE OF INDUSTRY OR BUSII'lE~S, Education
15. PLACE OF BIRTH Yonkers, NY
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
~. NAME Marino An~elo Vitulli
. B. COUNT~Y OF BIRTHU A .
17. MOTHER
A. MAIDEN NAME Eleonora Ann Calise
B. COUNTRY OF BIR'rHU S A
2
18. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES 19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV'1RCE CIVIL ANOULMENT DEaTH DI10RCE CIVIL A1)ULMENT DEdTH
B. HOW DID LAST MARRIAGE END? (3) i'1 DiVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) c;' DIVORCE (3) 0 ANNULMENT do~ DEATH
C. DATE LAST MARRIAGE ENDED? 01 / 29 / 2003' C. DATE LAST MARRIAGE ENDED? 07 / 31 / 2
MONT"", DAY YEAR . MONT~ DAY.'- YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? tJ YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? tJ YES 0 NO
~
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH. DAY, YEAR) (CITY/COUNTY. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
1ST 01/29/2003 Poughkeepsie, Ny 0 r1 1ST 07/31/2001 Putnam, County ~
2ND 0 0 2ND 0
3RD 0 0 3RD 0
4TH 0 0 4TH 0
I duly swear/affirm, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare t exists
as to my right to enter into the ma ge st . . ' .
21. SIGNATURE OF GROOM ~ IGNATURE OF BRIDE ~
DATE
05/05/2009
23. SUBSCRIBED AND SWORN TOI RMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in NeW York State" of the bride and groomriamed 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 01 a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) J C. Ma terson
TIME MONTH YEAR
SEAL SIGNATURE ~, . DATE 05/05/2009
I..- -.J MAIJ.I~. ,t\OD,aBER 10 06AM 05
-v- 2U IVI 0' ush Rd, Wappingers Falls, NY 12590 :
STREET CITY/TOWN STATE ZIP PM
~i~~RT':~ 6}O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY EAR 0 r.J RELIGIOUS
DATE AND AT THE TIME AND I AM ~
PLACE INDICATED. :J ~ 19 9 0 OTHER. SPECIFY
r, \'t.
by New York Domestic
MONTH
YEAR
07
04 2009
06
2009
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY 'D~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF jl( TOWN OF 0 VILLAGE OF
SPECIFY UJ~(I 1 ''5'''....; ~\ \.s
I
,D
TITLE.ttl (' '" I ~N
DATE~
N ':~ . 1 :).q.y-
ST TE