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COUNTY Dutchess
g:;;+:;rgWN 'Nappinger
~~~I~~~R 1368
NUMBER 93
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
.J
1. . A. FULL NAME
JolnlOO~nthony LamaiT SURNAME
11. A. FULL NAME
Lislilil~~glrie 8clafiftiENT SURNAME
FIRST
FIRST
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N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
B. BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
o SOCIAL SECURITY NUMBER 103 76 6308
2. RESIDENCE A. ~ 'V B. I II_~- r
I'II~TATE) ~)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND
SPECIFY Rochester
o STREET ADDRESS 129 S:Jmsonville Road ZIP 12"1"16
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3. A. AGE .., A 3B. DATE OF BIRTH ..a!) / <l..:z / ~ o.-z "
.:1"'t M~ 0"" YE,IiIllI..,.
4. EMPLOYMENT
C SURNAME AFTER MARRIAGE landi
(OPTIONAL' SEE REVERSE!
o SOCIAL SECURITY NUMBER 096 76 1979
12. RESIDENCE A. NY, B. UI~~M
(STATE) ~~)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND
SPECIFY Rochester
o STREET ADDRESS 12Q S.msonville Road ZIP 12446
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 00 NO
~c1.TH 1 gAY 4 ~.o
13. A. AGE 28
14. EMPLOYMENT
38. DATE OF BIRTH
A. USUAL OCCUPATION Carpenter
B. TYPE OF INDUSTRY OR BUSINESS Carpentry
5. PLACE OF BIRTH ~I~~m,c~~ l~gr~A)
6. FATHER
A. USUAL OCCUPATION Secretary
B. TYPE OF INDUSTRY OR BUSINESS Medic.1
15 PLACE OF BIRTH ~Bk\'c~~IIX~~A)
16. FATHER
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,A. NAME Stephan Solabni
B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Diane M.rie Dinsd.le
B. COUNTRY OF BIRTH USA
1 B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
DEATH
A. NAME Ronald Patrick Landi
B, COUNTRY OF BIRTH U S ,\
7. MOTHER
A. MAIDEN NAME Marie ^ntonicttc I\ntonicelli
B, COUNTRY OF BIRTH U S 1\
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
o 0
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
o
(2) 0 DEATH
o
o
(3) 0 ANNULMENT
/ /
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / (.
MONTH DAY YEAR
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
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) ICITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 0
o 0
o 0
o 0
al impedime'1t exists
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1ST
2ND
3RD
4TH
I duiy swear/affirm, depose and ay, t
as to my right to enter into the r'f'arna
21. SIGNATURE OF GROOM~ .l.......
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
wledge and belief that the information I provided is true
22. SIGNATURE OF BRIDE ~
SE
23. SUBSCRIBED AND SWORN TO/AFFI BEFORE ME
SIGNATURE OF TOWN OR CITY, C RK ~
This license authorizes the marriage in New rk State of the bride and groom named above by any person authorized
Relations Law !l11 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
DATE
07/23/2008
by New York Domestic
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{ SEAL}
'-v-I
NAME (PRINT)
YEAR
MONTH
YEAR
TIME
MONTH
DATE
AM
05:16PM
21 2008
07
24
2008
09
A
27. TYPE OF CEREMONY
o WRELlGIOUS
9 0 OTHER, SPECIFY
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
28. PLACE WHERE MARRIAGE OCCURRED
A, STATE NEW YORK B. COUNTY l)u.J.tI)) t'SS
10 CIVil
C. LOCATION OF CEREMONY
(CHECK ONE AND }l'ECIFY)
o CITY OF ~OWN OF IJ VilLAGE OF
-'::1 Sh kit {
29 OFFICIANT
NAME (PRINT)
TITLE ~"'-V'oc~~,\ \j.\.(....( 'r
DATE~
~ \:2-
SPECIFY
ZIP
31. WITNESS TO CEREMONY
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