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DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FtIieJ< Cont81~RENT SURNAME
23. SUBSCRIBED AND SWORN TCl/AFFIR
SIGNATURE OF TOWN OR CI CLE
This license authorizes th m rriage in ew York S e of the bride and groom named above by any person authorized
Relations Law ~11 to perlor rriage monies within New York State, THIS LICENSE VALID IN NEW YORK STATE ONLY.
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
COUNTY Dutchess
CITYITOWN \^'appinger
~~~:~c: 1368
~~~I~~~R 126
1 . A. FULL NAME
FIRST
a.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 093-54-8676
2. RESIDENCEA. NYsTATE) B. q~~ss
C. CHECK ONE 0 CITY,JlJ TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 1 O~ Pptpr Drivp ZIP 1 ?!i90
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES olJ NO
M~ / ~ / !ei60
3. A. AGE 18
4. EMPLOYMENT
3B. DATE OF BIRTH
A. USUAL OCCUPATION Contriilctor
B. TYPE OF INDUSTRY OR BUSINESS Constp Ictinn
5. PLACE OF BIRTH ~~,'Jm~~ct&T~J~'N~~SA)
6. FATHER
A. NAME Albert Richard Contelmo
B. COUNTRY OF BIRTH I I S A.
7. MOTHER
A. MAIDEN NAME AdelaidE' IO(;lnnp ~ti~kles
B. COUNTRY OF BIRTH I I S A
8. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
1
o
o
B. HOW DID LAST MARRIAGE END? (3) !!i'1 DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 03/?4 /
MONTH 0'1:'(
D. ARE ANY FORMER SPOUSE(S) ALIVE? &'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
031?4/?onA. Dllt~hp!=:!=: r.nl mty, Ny 0
o
o
o
(2) 0 DEATH
?OOA.
YEAR
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and
as to my right to enter Into the
21. SIGNATURE OF GROOM~
~
{ SEAL }
'-v-I
NAME (PRINT)
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kimb~l~ AnnE' \!p(l3M~TSURNAME
-.J
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Pariie
c. syg~~~~~~~rE'~~C~~l~fontelmo
D. SOCIAL SECURITY NUMBER 071-62-9329
12. RESIDENCE ANY B. Dlltchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY o/lJ TOWN 0 VILLAGE
AND W .
SPECIFY ::JrrlngAr
D. STREET ADDREss1 05 Peter Drive
ZIP 12590
o YES~ NO
AqR:l
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A, AGE44 3B. DATE OF BIRTH 1? /'j' 9
MNTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Fin::Jnr.i::J1 PI::Jnnpr
B TYPE OF INDUSTRY OR BUSINESS Financial Services
15. PLACE OF BIRTHPmJahkAAnsie, Nv
(CITY, lffATE / COUNTRY IF NOTDSA)
16. FATHER
A. NAME .Iohn Anthony P::Jri!=:p
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Margaret Bernice Jackson
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) I!'f DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 10 / 21 / 2002
MONTH DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~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 10/21/2002 Dutchess County. Ny ~
2ND 0
~D 0
22. SIGNATURE OF BRIDE~
DATE 09/03/2008
by New York Domestic
TIME
MONTH
YEAR
MONTH
YEAR
AM
07:04PM 09
11
02 2008
04
2008
ITY WN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY
~:QD ~M 10
STATE
27. TYPE OF CEREMONY
YEAR 0 ~ RELIGIOUS
iX072' 9 0 OTHER, SPECIFY
10 CIVIL
A. STATE NEW YORK B. COUNTY PVlCl-f€.55
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
~ CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY rout,..-H l"ie:T~i);;'/~
TITLE .9't:.. f /t5 '('0;::"
DATE 10 /..r / ~ ~
/':<s? I
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29. OFFICIANT
NAME (PRINT)
STATE
28. PLACE WHERE MARRIAGE OCCURRED
31. WITNESS
NAME (PRINT)
SIGNATURE~