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COUNTY Dutchess
CITYrrowN Wappinger
~~J~~~ 1368
~5~1:~~R 144
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Rodne~ Borland PlimRton
M OLE CUR ENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
-1
1. A. FUll NAME
FROM THE BRIDE
Geraldine Ann DeNunzio
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Prescott
C. SURNAME AFTER MARRIAGE PI i m pton
(OPTIONAl- SEE REVERSE)124_34_58 79
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. NY BDutchess
(ST A JiE) (COUNTY)
C. CHECK ONE '(] CITY 0 TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D. STREET ADDREss24 Beechwood Terrace ZIP 12601
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? ~ YES 0 NO
/f 8 )"944
DAY YEAR
11. A. FUll NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)007 36 7721
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A MA B. Middlesex
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Acton
D. STREET ADDRESS 4 Blue Heron Way ZIP 01720
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3. A. AGE 69 3B. DATE OF BIRTH 01 / 19 /1939
MONTH DAY YEAR
3B. DATE OF BIRTH
05
13. A. AGE 64
MONTH
4. EMPLOYMENT
A. USUALOC~UPATION Human Resources
B. TYPE OF INDUSTRY OR BUSINESS Utility
5. PLACE OF BIRTH FraminQham, Ma
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Barton Fiske Plimpton
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Beatrice Borland
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
14. EMPLOYMENT
A. USUAL OCCUPATION Self Employed
B. TYPE OF INDUSTRY OR BUSINESS Beauty
15. PLACE OF BIRTH Troy, Ny
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Francis Frederick Prescott
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Rose Mary Feletti
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 3
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DEATH DIVORCE CIVIL ANNULMENT
1 1 0 1
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 6 DEATH B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (210 DEATH
C. DATE LAST MARRIAGE ENDED? 08 / 13 / 2007 C. DATE LAST MARRIAGE ENDED? 12 / 24 / 2003
MONTH 'pAY YEAR MONTtt/' DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES ~ NO D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES 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, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 0 0 1ST 12/24/2003 Poughkeepsie, Ny 0 ~
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I duly sweilr/affirm, dep'ose and say, that to the best of my knowledge and belief that the information I provided is tr~ue d that I declare that no legal impediment exists'
as to my nght to enter Into the lage tate., - /J ~
21. SIGNATURE OF GROOM~ '. 22 SIGNATURE OF BRIDE~. ~
USE CURRENT NAME
DATE 09/24/2008
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
w
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23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE M
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New Yor 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
J n C. Ma terson
by New York Domestic
,-I'-..
{ } NAME (PRINT)
SEAL SIGNATURE ~
~ MAI~~~rJ
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
YEAR
MONTH
YEAR
TIME
MONTH
AM
05:03PM
09
25
2008
11
23 2008
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY -U~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFYJ<ett~Otl
m~
DATE q '7etJI
tv<\
STATE
NAME (PRINT)
SIGNATURE~