018
+
....
z
UJ
'"
UJ
'"
0
..J
=>
0
J:
'"
Z
0
~
....
'"
a
UJ
II: "
UJ
~
ii:
II:
-<
::l!
LL
0
UJ
~
u
ii:
>=
II:
UJ
U
UJ
II:
UJ II:
J: UJ
;: '"
'" ::l!
'" =>
UJ Z
II: 0
0 z
0 "
-< Iii
it w
II:
U ....
UJ en
Il.
'"
W
en
z
w
0
:J
+
z Z
II: 0 W
=>
t;:j ~ ~
II:
.... Z
'" ::l! 0
:;) UJ
::l! ..J u::
0
.... '" ~
z
-< LL
U 0 a:
ii: '" W
LL
0 > 0
w C'i
.. '"
0
z ;!;
0-
N
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Scott Peter Marsenison
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOwN.Wappinger
DISTRICT 1 :j68 .
NIIMoER
R[;GISTER 18
NUMBER
1 . A. FUll NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)130_56_6585
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY o(J TOWN 0 VILLAGE
~~~CIFY PouQhkeepsie
D. STREET ADDRESS 40 Cochran Hill ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES tJ NO
3. A. AGE 34 3B. DATE OF BiRTH 09 / 20 / 1974
MONTH OA Y YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Groundskeeper
B. TYPE OF INDUSTRY OR BUSINESS Lawn Care
5. PLACE OF BIRTH Manhattan, NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Peter Thomas Marsenison
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Marsha Lois Newirth
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
I
I
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(2) 0 DEATH
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L
~UQM~::'!. ()l5fb 2- 5~
(3) 0 ANNULMENT
/ /
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
11. A. FULL NAME
FROM THE BRIDE
Danielle Marie Schiavone
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Schiavone-Marsenison
(OPTIONAL. SEE REVERSE)056_66_7658
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY East Fishkill
D. STREET ADDRESS 130 Woodcrest Drive
ZIP 12033
DYES rJ NO
/1'981
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 27 3B. DATE OF BIRTH 09 ~1
MONTH DAY
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Education
15. PLACE OF BIRTH Bronx, NY
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Michael Albert Schiavone
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Karen Carmela Waag
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
/ /
- YEAR
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) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say,
as to my right to enter into the mar
/
21. SIGNATURE OF GROOM~ . "
o 1ST
o 2ND
o 3RD
o 4TH
belief that the information I provided is
o 0
o 0
o 0
o 0
leg I il'QPediment exists
~
DATE 04/06/2009
by New York Domestic
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.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRIND Joh
{ ~ ~ ~
SEAL SIGNATURE ~
MAILING ADDRESS AM
'-v-I 20 Middle us 12:42PM 04 07 2009
STREET
I CERTIFY THAT J SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
MONTH
YEAR
06
05 2009
d O~ AM _' /) _ ()
29. OFFICIAW 1D fa (d it 'D 111 (l 10 0 S
NAME (PRINT~ I':> J
SIGNATURE~dn~~ ~fJ-,y
MAILING ADDRESS r J. ~' 1 " \ lj
I "I IkJ c r' n\. :> -t' - N ~ C. I'"
STREET CITYfT WN
30. WITNESS TO CFeEMONY
NAME (PRIND C ;-\ ...\\\\t ('
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
TITLE
DATE
10 () (~
SIGNATURE"
OOH-98 (0312006)
A9JY7
''/ ti) - 09
28. PLACE WHERE MARRIAGE OCCURRED New or~
A. STATE NEW YORK B. COUNTY M R'N &tAl iAiV
LOCATION OF CEREMONY
(C'JCK ONE AND SPECIFY)
.q CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY IJ C ""I. .x r K
STATE
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~
_~IISTATE OF NEW YORK
.,., DEPARTMENT OF HEALTH
Corning Tower
The Governor Nelson A. Rockefeller Empire State Plaza Albany, New York 12237
Wendy E. Saunders
Executive Deputy Commissioner
Richard F. Daines, M.D.
Commissioner
July 1, 2009
John C Masterson
Town Clerk
20 Middlebush Road
Wappingers Falls NY 12590
Re: Scott Peter Marsenison & Danielle Marie Schiavone - DOM 04/1 0/2009
Dear City/Town Clerk,
The affidavit to correct a marriage record has been received. In order to process this case, please submit the
documents requested below with this letter.
/' We need a letter from the Officiant on official stationary. The letter must state the bride and
grooms name, date of marriage what the error is and what it is to be corrected to.
The Domestic Relations Law limits the authority of the New York State Department Of Health to correct
information provided by marriage license applicants only when it has been demonstrated that the error was caused
by inadvertence.
DOCUMENTS SUBMITTED MUST BE ORIGINALS OR CERTIFIED PHOTOCOPIES.
A photocopy of the document is not acceptable unless it has been verified by a notary public or an attorney. Your
case CANNOT be processed without proper documentation of the correct information.
The correction could take up to 6 months if this is a current marriage. If you have any questions, please contact
the Corrections Unit at the address below or by phone at: (518) 474-2013.
Thank You,
Linda Ortiz
NYS Department of Health
Vital Records/Correction Unit
PO Box 2602
Albany NY 12220-2602
+
....
z
W
UJ
W
'"
o
...J
~
o
:I:
UJ
Z
o
~
'"
lii
15
W
'" "
w
(!)
<
lr
'"
<
:;;
u.
o
w
!;(
o
u:
;:::
'"
w
o
W
'"
W
~
UJ
UJ
W
'"
o
o
<
~
13
W
Cl.
UJ
","
W
'"
:!
=>
z
o
z
<
tii
W
a:
In
w
en
z
-w
o
::l
+
Z' .
~E~ w
I- 3:.... ....
:l!"a:~ ..,
I-WZ -
3tJ~ 0
~~~ u::
~~~ ~
iEOOO W
01->
wli!~ 0
bai'"
zg~
0-
N
COUNTY Dutchess
CIT'ffTOWN Wappinger
~~J.~~c; 1 368 .
~~~~~~R 1 8
~ 11"\ I.... "'I 1'1...... 1 "'1"'-
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Scott Peter Marsenison
MIDDLE CURRENT SURN"'ME
I InlO C'J~.Mvl:: rvn .;3/"Il:: 1J~r;; ",,'VL.I/
L
~uQM~:"! UUOo 2- ~
1. A. FULL NAME
11. A. FULL NAME
FROM THE BRIDE
Danielle Marie Schiavone
FIRST MIDDLE CURRENT SURNAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 130 56 6585
D. SOCIAL SECURITY NUMBER --
2 RESIDENCE A. NY B. Dutchess
(STATE) . (COUNTY)
C. CHECK ONE 0 CITYoO TOWN 0 VILLAGE
~~~CIFY Pouqhkeepsie
o STREET ADDRESS 40 Cochran Hill ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES tJ NO
3. A. AGE 34 3B. DATE OF BIRTH 09 / 20 /1974
MONTH DAY YEAR
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Schiavone-Marsenison
(OPTIONAL. SEE REVERSEl056_66_7658
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A NY B. Dutchess
(STATE) J. (COUNTY)
C. CHECK ONE 0 CITY i:.J TOWN 0 VILLAGE
~~~CIFY East Fishkill
D. STREET ADDRESS 130 Woodcrest Drive
ZIP 12533
o YES.~ NO
;1'981
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 27 3B. DATE OF BIRTH 09 ,/01
MONTH D... Y
4. EMPLOYMENT
A. USUAL OCCUPATION Groundskeeoer
B. TYPE OF INDUSTRY OR BUSINESS Lawn Care
5. PLACE OF BIRTH Manhattan. NY
(CITY, STATE / COUNTRY IF NOT US"')
6. FATHER
A. NAME Peter Thomas Marsenison
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Marsha Lois Newirth
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARI3IAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Education
15. PLACE OF BIRTH Bronx, NY
(CITY. ST...TE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Michael Albert Schiavone
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Karen Carmela Waag
B. COUNTRY OF BIRTH USA
1B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
o 0
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. . - YEAR
C. DATE LAST MARRIAGE ENDED?
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) (CITY/COUNTY. ST...TElCOUNTRY. IF NOT US"') SELF SPOUSE
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) (CITYICOUNTY. STATE/COUNTRY, IF NOT US"') SELF SPOUSE
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say,
as to my right to enter into the ma .
f
21. SIGNATURE OF GROOM ~ ..
o 1ST
o 2ND
o 3RD
o 4TH
belief that the information I provided is
o 0
o 0
o 0
o 0
eg I i~edjmenl exists
~
22. SIGNATURE OF BRIDE ~
DATE
04/06/2009
YEAR
TITLE
Aw:>
'el tv - 09
( ..
28. PLACE WHERE MARRIAGE OCCURRED New or\.(
A. STATE NEW YORK B. COUNTY fJt R-N btNI 14i
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
..iCITY OF 0 TOWN OF 0 VilLAGE OF
SPECIFY~J C &.<A. y;. r K
DATE
1001-7
STATE ZIP
31. WITNESS TO CEREMONY
C\ \ .
..)~, (AV \l\'\~ NAME (PRINT)
SIGNATURE~
STATEOF NfUJ V()r~ } SS'
COUNTY OF J:1t1WI nger .
We, S C o-H 1~J1~Sf/n i.s 0 n
(Groom)
Affidavit for
Correction of Marriage Record
FOR OFFICIAL NYS USE ONLY
NEWYORK STATE DEPARTMENT OF HEALTH
Vital Records Section
and
State File #
Groom:
Bride:
Date Completed:
being severally sworn, depose and say that:
) (' t '. LI
1 . We reside at: . {I
.tp"f~~sS) (\ L 'l'~l/"l Di\ nltJ p r (State)
2. Marriage License issued by.Cityffown: I LJ~T ~ \ J-V
3. Date of Marriage: fJorJ J 10, :JODq . .'
I J
4. Error(s) appearing on record (list exactly):
a. eOUnf\Jof r0anhat+-an [BlOCt{ # :29)
b. T,'+}e I .frbM [J3locU -It 1(1)
-a3
c.
5. Correct information as it should appear (list exactly):
a. tOllnf\l OF . N-ew \for v<
b. /jt)e :IAdn)inistrawr
c.
6. Documentation Submitted:
a. Cfttifi (O,tf)
Of
M(lr-ri 00 -{,
b.
c.
This affidavit with supporting documentation is being made for the purpose of havin -the record of marriage show the
true facts and this affidavit will become a permanent record. The marriag / ecor ,s file . ith the St~te of New York.
DANIEL PAEZ
Notary Public - State ot New York
NO. 01 PA6189823
Qualified in Dutchess Count
My Commission Expires ).....
~
~
Signature of Wife
Subscribed and sworn to
(affirmed) before me this
day of
M/\ l?
tJX:A
,
Notary Public ~
;],
NOTE:
required for notary public outside New York State
DOH-1827 (05/2004)
( over)
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
CHRISTOPHER J. COLSEY
July 7,2009
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
WILLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOlONI
J oraida Burgos
141 North St.
New York, NY. 10013
Dear Mr. Burgos,
My office has received the Marriage License for the marriage of Scott Peter Marsenison and
Danielle Marie Schiavone, which you performed on April 10, 2009. At the time of licensing,
my office provided the couple with a memo that would assist you in the completion of block
#28. The information that you entered into block #28 is incorrect. There is no "County of
Manhattan" also the Officiant title was illegible.
Although the couple has submitted the Affidavit for Correction of Marriage License, which
we forwarded to New York State for correction, we have been notified by the Department of
Health that in order for them to process this case we must receive a letter from the Officiant
on official stationary. The letter must state the bride and grooms name, date of marriage what
the error is and what it is to be corrected to.
DOCUMENTS SUBMITTED MUST BE ORIGINALS OR CERTIFIED PHOTOCOPIES.
Please mail documentation to my office at your earliest convenience.
~e~
hn C. Masterson
Town Clerk
Town of Wappinger
cc: Scott Peter Marsenison
Danielle Marie Schiavone
JeMlcf
STATEOF~._lQ Yon{ }
\^In mi' hIlo r SS'
COUNTYOF~ .
Affidavit for
Correction of Marriage Record
FOR OFFICIAL NYS USE ONLY
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
We,
3co~
Mar&ni.son
(Groom)
and
State File #
Groom:
Bride:
Date Completed:
being severally sworn, depose and say that:
1. We reside at: ) 60 \cl.oo..d.cf e.s t
t
NL(
r (State)
)J/;a3
(Zip Code)
2. Marriage License issued by Cityrrown:
3. Date of Marriage lJ.prJ J 10) '20Dq
4. Error(s) appearing on record (list exactly):
a. Count\) of Marlhar+an lBIO{v( +f 29)
b. 'r,' t) e I A-bM (" 310cu tt- 1q)
c.
5. Correct information as it should appear (list exactly):
a. -C OUnt\J QJ- N-cw YOr ~
b. 'Tj t }e ~ I Ad ffiln i~tratv(
c.
6. Documentation Submitted:
a. ittfL-f(' (0 t()
Of
M(lrna8~
b.
c.
This affidavit with supporting documentation is being made for the purpose of havin -the record of marriage show the
true facts and this affidavit will become a permanent record. The marriag 'ecor s file ith the St~te of New York.
DANIEL PAEZ
Notary Public. State of New York
NO.01PA6189823
Qualified In Dutchess ount
My Commission Expires . 1-
~
L6V--
~
Signature of Wife
day of _MI\~
"2fXA
Subscribed and sworn to
(affirmed) before me this
Notary Public ~
NOTE:
required for notary public outside New York State
DOH-1827 (05/2004)
(over)
..
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
CHRISTOPHER J. COLSEY
April 16, 2009
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
WILLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
Scott Mardenison
Danielle Schiavone
130 W oodcrest Drive
Hopewell.Tct., NY 12533
Dear Scott and Danielle;
My office has received your Marriage License for your marriage that was performed on
April 10, 2009. At the time of licensing, my office provided you with a memo that would assist
the Marriage Officiant in the completion of block #28. The information that was entered into
block #28 is incorrect. There is no county by the name of "Manhattan" and the city was left
blank.
Additionally, the title of the marriage officiant is illegible.
Finally, the upper right hand corner is for State Use only. I do not know why the
marriage officiant filled in that section and I don't know how you would correct it.
I am returning the original "Affidavit, License and Certificate of Marriage" to you for
correction. Please mail it back to my office at your earliest convenience. If you have any
questions please contact my office at (845) 297-5771
Sincerely,
Otr1lLb
.Tthn C. Masterson
Town Clerk
Town of Wappinger
+
t-
Z
W
CIJ
w
a>
o
...J
'"
o
:r
CIJ
z
o
~
t-
CIJ
Ci
w
a:"
w
CJ
<
it
a:
<
:::;
u.
o
W
t-
<
()
u:
j::
a:
w
()
w
a:
w
:r
~
Vi
CIJ
w
a:
o
o
<
~
u
W
0-
CIJ
a:
w
"'
:::;
"
z
o
z
<
Ii;
w
a:
ti;
+
~:i::i W
",t:Q
tii~t- ....
a:"'~ <
~~~ 0
;)()w
~gg u:::
~~~ Ii:
!tOCIJ W
ot->- 0
W~~
b~U)
Z::i1!:
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Scott Peter Marsenison
MIDDLE CURRENT SURNAME
CO~JNTY Dutchess
CITYfTOWN Wappinger
~~~~~c; 1368
~5~liJ~R 1 8
1. A. FULL NAME
FIRST
ll.
N
B. BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)130_56 6585
D. SOCIAL SECURITY NUMBER -
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY -tJ TOWN 0 VILLAGE
~~~CIFY Pouqhkeepsie
o STREET ADDRESS 40 Cochran Hill ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES'6 NO
09 /20 /1974
DAY YEAR
3. A. AGE 34
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Groundskeeoer
B. TYPE OF INDUSTRY OR BUSINESS Lawn Care
5. PLACE OF BIRTH Manhattan, NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Peter Thomas Marsenison
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Marsha Lois Newirth
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?
(2) 0 DEATH
(3) 0 ANNULMENT
/ /
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:>>I"'I~ rlL..C:: l'4umac::n
(THIS SPACE FOR STA TE USE ONL Y)
L
ttQM~:'! lj?)1Jo 2- ~~
11. A. FULL NAME
FROM THE BRIDE
Danielle Marie Schiavone
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Schiavone-Marsenison
(OPTIONAL. SEE REVERSE)056_66_7658
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY East Fishkill
D STREET ADDRESS 130 Woodcrest Drive
ZIP 12533
DYES '6 NO
)1'981
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE?
13. A. AGE 27 3B. DATE OF BIRTH 09 ~1
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Education
15. PLACE OF BIRTH Bronx, NY
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A NAME Michael Albert Schiavone
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Karen Carmela Waag
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
22. SIGNATURE OF BRIDE ~
o 0
o 0
o 0
o 0
leg I inyJediment exists
~
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say,
as to my right to enter into the mar .
o 1ST
o 2ND
o 3RD
o 4TH
belief that the information I provided is .
W
en
z
W
o
:i
TITLE
DATE
iDO I?
SIGNATURE~
DOH.98 (03/2006)
--
21. SIGNATURE OF GROOM ~., .
23. SUBSCRIBED AND SWORN TO/~IRMED BEFORE ME E
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-I'-.. 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Joh
{TIME MONTH YEAR MONTH
SEAL SIGNATURE.
MAILING ADDRESS AM
'-v-I 20 Middle 12:42PM 04 07 2009 06 05 2009
STREET ZIP
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
DATE
04/06/2009
YEAR
1-
CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY fJ( A-N blATT4.
C. LOCATION OF CEREMONY
(C'JCK ONE AND SPECIFY)
.q CITY OF 0 TOWN OF 0 VILLAGE OF
A9JY7
'~/ (D - 09
SPECIFY
STATE ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE.