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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Pa'IL~chary RII~~~isURNAME
US
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New Yo State of the bride and groom named above by any person authorized
Relations Law 911 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o " 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)
COUNTY nlltchess
CITYiTOWN Wappinger
~~~~~c~ 1 ~6R
~~~I~~~R 70
1. .A FULL NAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER 1 ?1-FiO-?611
2 RESIDENCE A. NYsTATE) B [;ty~~ess
C. CHECK ONE 0 CITY oIlI TOWN 0 VILLAGE
AND \^/ .
SPECIFY ~rrlnoPr
D. STREET ADDRESS 10 n;:lvirJ loop ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3 A. AGE 47 3B. DATE OF BIRTH MO~ /~;> / y1gso
4. EMPLOYMENT
....
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<C
C
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~<C
A USUAL OCCUPATION Carpenter
B. TYPE OF INDUSTRY OR BUSINESS r.on!=:tn Ir.tion
5. PLACE OF BIRTH Pro\lirlpnr.p,-,_ RI
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Anthony R'lggieri
B. COUNTRY OF BIRTH I J S A
7. MOTHER
A. MAIDEN NAME A!=:!=:llnt;:) Antonelli
B. COUNTRY OF BIRTH II S A
8. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGESWHICHENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
1
o
a:
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B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE 13) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 03/?8 /
MONTH DTW
D. ARE ANY FORMER SPOUSE(S) ALIVE? iYVES 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
01/?R/?OOO nlltr.he!=:!=: r.ollnty. Ny [!i!' 0
o 0
o 0
(2) 0 DEATH
2000
YEAR
1ST
2ND
3RD
4TH
I duly swear/affirm. depose and sa I
as to my right to enter into the na
21. SIGNATURE OF GROOM ~
~
{ SEAL }
"-v-'
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
DeboJ;8lt'E C(;lrol CC{~~T SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SYS~*~'W..r~~~e^~~b~~s~uggieri
o SOCIAL SECURITY NUMBER 111-54-736/
12. RESIDENCE A. N~STATE) B. Dlt.!tg~'3'3
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W .
SPECIFY ;:)rplnoer
D. STREET ADDRESS 10 David Loop ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES otJ NO
13. A. AGE 49 3B. DATE OF BIRTH j 1 a 1 4QI;8
MONTH ~A Y 'fEAR
14. EMPLOYMENT
A. USUAL OCCUPATION M~~!=:~oe Ther~ri!=:t
B. TYPE OF INDUSTRY OR BUSINESS Ther;:lpy
15. PLACE OF BIRTH H~rtforrl CT
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Gerard l(;lmE'S C8rney
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME C;:lrol Ann Freel;:lnrJ
B. COUNTRY OF BIRTHl J 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) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? OR / 01 / 1 qq7
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 ORtn1/1 qq7 nlltC':he~~ County NY 0
2ND 0
3RD 0
by New York Domestic
TIME
YEAR
MONTH
YEAR
MONTH
AM
01:10PM
08
12 2008
06
14
2008
ITY
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
STATE
27. TYPE OF CEREMONY
o ~ RELIGIOUS
9 0 OTHER. SPECIFY
A. STATE NEW YORK B. COUNTY
:~ M (,
~~~lf~~;mT ~lif</J...Y L. WW.5 TITLE OR blilN~
SIGNATURE~ ~~~ ;I!' ~ DATE (, IJq !Of/
MAILING ADDRESS N r. I
~l./-o f(A/NBow BWb. IAGfitJ.A r1'tl~-1 NY
STREET CITYiTOWN STATE!
30. WITNESS TO C~EMONY
NAME (PRINT) V A u..
{q
08'
SIGNATURE~
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
M IA'liltl1
Pltl6ST
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
~TY OF 0 TOWN OF 0 VILLAGE OF
tV Iii 61'1 AA fit t.l..S
IlfJ()3
ZIP
31. WITNESS TO CEREMONY
SPECIFY
NAME (PRINT)
SIGNATURE~
