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COUNTY Dutchess
CITYfTOWN Wappinger
DISTRICT 1368
NUMBER
~~~~~~R 169
~ I A It: UI- Nt:W YUHI\
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
John Frederick Vitale
MIDDLE CURRENT SURNAME
CURRENT SURNAME
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Marianne Dolores Callan
~
1. A. FULL NAME
11. A. FUllNAME
FIRST
FIRST MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Cerce
C. SURNAME AFTER MARRIAGE Vitale
(OPTIONAL' SEE REVERSE)079-44-5260
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. NY B Dutchess
(STATE).L (COUNTY)
C. CHECK O~ 0 CITY [j TOWN 0 VILLAGE
~~~CIFY l-'ougnKeepsle
D. STREET ADDRESS 5t) camelot Koad ZIP -lLeo -I
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES ~ NO
13. A. AGE 54 3B DATE OF BIRTH 08 ~6 ;t 54
MONTH DAY YEAR
"'-
N
B. BIRTH NAME, IF DIFFERENT
MONTH
YEAR
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4. EMPLOYMENT
A. USUAL OCCUPATION Buyer
B. TYPE OF INDUSTRY OR BUSINESS Semi-conductor
5. PLACE OF BIRTH Philadelphia, Pa
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Frederick O. Vitale
B. COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Janet Marilyn Cramp
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
14. EMPLOYMENT
A. USUAL OCCUPATION Teaching Assistant
B. TYPE OF INDU~RY QR .BUSINf,iS,S S U F S 0
15. PLACE OF BIRTH USSlnlng, NY
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Louis Raymond Cerce
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Antoinette Marie Agnello
B. COUNTRY OF BIRTH USA
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
DIVORCE CIVIL ANNULMENT DEATH DIVORCE CIVIL ANNULMENT DEATH
1 0 0 1 0 U
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) 6 DIVORCE (3) 0 ANNULMENT 929S DEATH
C. DATE LAST MARRIAGE ENDED? 09 / 28 / 1993' C. DATE LAST MARRIAGE ENDED? 02 / 22 / 1
MONTfi.,I DAY YEAR MONT'V DAY, '. - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? aYES 0 NO D. ARE ANY FORMER SPOLlSE(S) ALIVE? 0 YES 0 NO
to
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, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
09/28/1993 Poughkeepsie, Ny 0 6 1ST 02/22/1994 Poughkeepsie, Ny 0 ~
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
owledge and belief that the information I provided is true and that I declare that no legal impediment exists
. SIGNATURE OF BRIDE~ 1J1~ 10 . t/; }.J /J..4U
USE CURRENT NAME
DATE 11/03/2008
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say, th
as to my right to enter into the marn
21. SIGNATURE OF GROOM ~
w
(J)
Z
W
o
::i
YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AN
PLACE INDICATED.
28. PLACE WHERE MARRIAGE OCCU~
A. STATE NEW YORK B. COUN~TtJk:iS
C. LOCATION OF CEREMONY
(CHECK ONE AND YC1FY)
o CITY OF c00WN OF 0 VILLAGE OF
"" A,-pPI ~~
SIGNATURE~ .
DOH-98 (03/2006)
SIGNATURE~ .