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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
COUNTYDutch€lSS
CITYiTowN\Napping€lr
DISTRICT
NUMBER a 36S
REGISTE
NUMBER 81
1 . A FULL NAME
~J&.f=rod BiagbRRENT SURNAME
FIRST
0..
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER 1 32 7 <1 0750
2. RESIDENCE A. NY B 0' '+1"'1-.088
(STATE) (~'i'fF'
C CHECK ONE 0 ClTYJJ TOWN 0 VILLAGE
AND
SPECIFY Wappinger
D. STREETADDREss7 Alpine Dri\le; Ilnit D ZIP 1?!1QO
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YEs.{] NO
M~ / ~~ /1~15
3. A AGE33
4, EMPLOYMENT
3B, DATE OF BIRTH
A USUAL OCCUPATION L3borer
B TYPE OF INDUSTRY OR BUSINESS Con5itp Iction
5. PLACE OF BIRTH~~ ~~f,~ ~~
i ,S A / c'Ju IF NOT USA)
6. FATHER
A. NAME Roger Biagi
B. COUNTRY OF BIRTH IJ S A
7. MOTHER
A MAIDEN NAME Mary 4.nn Speranza
B. COUNTRY OF BIRTH U S P.
8, NUMBER OF THIS MARRIAGE 1
9, PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
'DIVORCE"'-'" "-'-cJVlL'ANMJtMENT
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
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Joan@~L~narie Me~tNT SURNAME
I
--'
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. sYS~*~~~~~~~t~~c~~~)iagi
D. SOCIAL SECURITY NUMBER 1 nO-FiR-O 1 ~4
12, RESIDENCE ANY (STATE) B~J;m)SS
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND \^' .
SPECIFY crrmoAr
D STREET ADDRES~ Alpine Drive; Unit 0 zIP12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YE5"'tJ NO
13. A. AGE35 3B. DATE OF BIRTH ~NTH d~AY ;(9yL~
14. EMPLOYMENT
A. USUAL OCCUPATIONGllid~mce enl In!::Alnr
B. TYPE OF INDUSTRY OR BUSINEssFrllJCation
15. PLACE OF BIRTHC(c~g~Tt~ 60~JRY IF NOT USA)
16. FATHER
A. NAMERichard 8ello'^'s M~~dA
'B. COUNTRY OF BIRTK J S A
17. MOTHER
A. MAIDEN NAMER::lrh::m:J .IAan Thompson
B. COUNTRY OF BIRTK J S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
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
o
o
o
1ST
2ND
3RD
4TH
I duly swear/affirm, depose a
as to my right to enter into th
21, SIGNATURE OF GROOM ~
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
to the best of my knowledge and belief that the information I provided is true and that
state.
U
23. SUBSCRIBED AND SWORN T I FFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonie 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
w
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(.)
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{ SEAL }
'-..t-I
NAME (PRINT)
22. SIGNATURE OF BRIO
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
TIME
MONTH
YEAR
MONTH
DAY
YEAR
DAY
07 Jn~'?OOR
11:34AM 07
PM
04
2008
09
01 2008
ZIP
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
STATE
27. TYPE OF CEREMONY
o tiI RELIGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY :)e lalJ.k ,.p
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY <OX bu (" 1
09
63
TITLE
SIGNATURE~
DOH-98 (03/2006)
MI,....,'<;-!-e....
31. WITNESS T~REMONY
NAME (PRINT) )c:Ol?tR:r B/~GI
SIGNATURE~ ----7 -:~