142 0.. N + w !.( ... en o::t N L(') N ......... ~ ~>- :> ~Z ~ o _ 5= w U. ~:.;;:~ ~ Ul.r:: - .... ~.~~ f-LLo ~ ~ a co c.> ~~ ~>< "CO ~~ Ii.. 00') w...... !;(o::t ~~ >= " W o W " W :I: ;= Ul Ul W " o o .. ~ 13 w ll. Ul STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM Ronald Damon DiVestea MIDDLE CURRENT SURNAME COUNTY Dutchess CITYfTOWN Wappinger ~~~:~c:1368 ~G~I~~~R 142 1 . A. FULL NAME FIRST B. BIRTH NAME, IF DIFFERENT C. SURNAME AFTER MARRIAGE (OPTIONAL - SEE REVERSE)1 06 64 5437 D. SOCIAL SECURITY NUMBER -- 2 RESIDENCE A. NY B Dutchess (STATE) (COUNTY) C. CHECK ONE 0 CITY~ TOWN 0 VilLAGE ~~~CIFY Fishkill D. STREET ADDRESS 1419 Max Way ZIP 12524 E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES~ NO 03 /28 /1975 MONTH DAY YEAR 3. A. AGE 33 3B. DATE OF BIRTH I STATE FILE NUMBER (THIS SPACE FOR STA TE USE ONL Y) I 4. EMPLOYMENT A. USUAL OCCUPATION Concieroe B. TYPE OF INDUSTRY OR BUSINESS Hospital 5. PLACE OF BIRTH Bronx, Ny (CITY, STATE I COUNTRY IF NOT USA) 6. FATHER A. NAME Ronald Joseph DiVestea B. COUNTRY OF BIRTH USA 7. MOTHER A. MAIDEN NAME Gloria M. Scarano B. COUNTRY OF BIRTH USA B. NUMBER OF THIS MARRIAGE 1 9. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT o 0 DEATH o L 0 SUPPLEMENTAL FILE FROM THE BRIDE Arlene Marie DiPietro MIDDLE CURRENT SURNAME ~ B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE C. DATE LAST MARRIAGE ENDED? (3) 0 ANNULMENT / / (2) 0 DEATH 11. A. FULL NAME FIRST 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 o o B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT C. SURNAME AFTER MARRIAGE DiVestea (OPTIONAL - SEE REVERSE071_62_2367 D. SOCIAL SECURITY NUMBER 12. RESIDENCE ANY BDutchess (STATE) (COUNTY) C. CHECK ONE 0 CITY tJ TOWN 0 VILLAGE o :~:~~ ::~!~n~~~hOny Drive ZIP 12590 DYES 1] NO ;1'964 YEAR E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 13. A. AGE44 3B DATE OF BIRTH 09 "l2 MONTH DAY 14. EMPLOYMENT A. USUAL OCCUPATIONAccount Manager B. TYPE OF INDUSTRY OR BUSINESS Health Care 15. PLACE OF BIRTHPoughkeepsie, NY (CITY. STATE I COUNTRY IF NOT USA) 16. FATHER A. NAMEAnthony DiPietro 'B. COUNTRY OF BIRT~taly 17. MOTHER A. MAIDEN NAME Kathleen Marie Metallo B. COUNTRY OF BIRTHU S A 1 B. NUMBER OF THIS MARRIAGE 1 19. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT o 0 DEATH o (3) 0 ANNULMENT (2) 0 DEATH / / - YEAR B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE 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 o o o 1ST 2ND 3RD o 0 o 0 o 0 o 0 iment exists ,,' W III ~ ::> z o z .. I- W W " Iii 21. SIGNATURE OF GROOM ~ US U 23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME SIGNATURE OF TOWN OR CITY CLERK ~ This license authorizes the marriage in New rk 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 (PRINT) J h C. Masterson { . ~ ~ ~ SEAL SIGNATURE ~ U.,' . DATE 09/24/2008 '-..,-I MA~15GIOO'trd~ ush Rd, Wappingers Falls, NY 12590 11 :52AM 09 25 2008 STREET CITYITOWN STATE ZIP PM ~~~R~:RT~~~ 10~0~~~N~i~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 jI:l RELIGIOUS DATE AND AT THE TIME AND PLACE INDICATED. 0 J e D 6 9 0 OTHER, SPECIFY w en z w 0 :J + ~~~ W ~~j:: ~ ",,;S ~~~ 0 ::lOW ::>Clc5 u: f-ZUl j:: z- 5~~ a: {Eoen W 0"'>- 0 ..w~ I!!~", o~ z::;;:; W~~~\:rf, ~. ~~ SIGNATURE ~ ' ~ MAILING ADDRESS J fb ~iMl 1. #11 p.. !3f;./kfJl'V STREET CITYfTOWN 3D. WITNESS TO CEREMONY 22. SIGNATURE OF BRIDE ~ DATE 09/24/2008 by New York Domestic MONTH YEAR 11 23 2008 28. PLACE WHERE MARRIAGE OCCURRED 10 CIVIL A. STATE NEW YORK B. COUNTY~TC;.e.S' C. LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) TITLE ~roa- DATE ;b-JB-,tif? JJ)' 1;:1.S-0~ STATE o CITY OF~ ,"'VI' or ~ VILLAGE OF SPECIFY r:) $H t;:.)/,L !f!JL} fJ/'r'l %/Y/V RoJ/TE..