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:s I A II:. Ut" NI:.W YUHI\
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Pet~bo&nthony L~~SURNAME
COUNTY Dutche5s
CITYfTOWN \^'appinger
~~~:~c; 1368
~5~1;;~R 99
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER OQ2-7 8- 3797
2. RESIDENCE A. NV B. n"t"hess
(IlTATE) ~
C. CHECK ONE 0 CITY 0 TOWN oltl VILLAGE
~~~CIFY \'^'apping~rs Falli
o STREET ADDRESS 18 North GilfYlore Rlvd ZIP 1 ?Fiqn
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? l2l YES 0 NO
MO~ / ~f / y1i88
3. A. AGE 20
4. EMPLOYMENT
3B. DATE OF BIRTH
A. USUAL OCCUPATION Aviation Technician
B. TYPE OF INDUSTRY OR BUSINESS United States Na"y
5. PLACE OF BIRTH fcl~~ ~AQE~~O~~~~ NO~XA)
6. FATHER
A. NAME Peter Charles Letizia
B. COUNTRY OF BIRTH 'I S A
7. MOTHER
A. MAIDEN NAME Sheri Ann Hallpt
B. COUNTRY OF BIRTH "S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
(2) 0 DEATH
o
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(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
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
A,~~y Ari81 B~RRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER 067 -76-526R
12. RESIDENCE A. NXSTATE) B. D\&b~S5
C. CHECK ONE 0 CITY 0 TOWN li!1 VilLAGE
~~~CIFY '^'appingers Falls
D. STREET ADDRESS?? 4n WP.~t M~in Strp.et ZIP 1 ?!i90
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? otJ YES 0 NO
13. A. AGE 1 Q 3B. DATE OF BIRTH Q.lNTH ~~AY /'j' ~~
14. EMPLOYMENT
A. USUAL OCCUPATION Manager
B. TYPE OF INDUSTRY OR BUSINESS Rp.t~il
15. PLACE OF BIRTH Yc~.~T~E!r;'~~'JaRY ~XOT USA)
16. FATHER
,A. NAME Michael Anthony Bell
B. COUNTRY OF BIRTH'I S A
17. MOTHER
A. MAIDEN NAME .Inh::mn~ Hp.rminp. Sr.hmirl
B. COUNTRY OF BIRTH~p.rm~ny
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o
o
DEATH
n
(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 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
nOw~dge and belief that the information I provided ~ and
22. SIGNATURE OF BRIDE.
o 0
o 0
o 0
o 0
I impediment exists
USEC
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
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say, th
as to my right to enter into th~ mama
21. SIGNATURE OF GROOM.
W
en
z
W
o
::i
~
{ SEAL}
'-v-'
NAME (PRINT)
DATE
07/30/2008
by New York Domestic
TIME
MONTH
DAY
YEAR
MONTH
YEAR
AM
06:41 PM 07
31
2008
09
28 2008
ITY
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
'fiofO
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
1~VIL
28. PLACE WHERE MARRIAGE OCCURRED
A, STATE NEW YORK B. COUNTY hV1Ct.{tS~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WN OF 0 VILLAGE OF
mc<1tt46E ~ILf<<'"
DATE [ooB
IG5'10
STATE
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
OATE AND AT THE TIME AND
PLACE INDICATED.
~oo'i'
29. OFFICIANT
NAME (PRINT)
Rus f-J
SIGNATURE~
DOH.98 (03/2006)
SPECIFY \AJAPP JtJ6E.~
NAME (PRINT)
SIGNATURE~