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070 + .... z w CIJ w CD Cl --' ::J o I CIJ Z o ;:: <(. a: .... CIJ a w a: w Cl <( a: a: <( :;; u. o w ..... <( () u: ;:: a: w () w a: w I ~ CIJ CIJ w a: Cl Cl <( >- u. U W 0- CIJ w en z w 0 :i + z Z a: 0 W ::J .... ;:: .... w ;S a: <C .... z CIJ :;; 0 ::J W :;; --' u: 0 .... CIJ ~ Z <( u. U 0 a: u: u. CIJ W 0 >- 0 <( w 0 t- '" 0 z ;:; 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 .... :> <C C "'U: "'u.. ~<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: '" '" :; ::> z " z <( .... '" '" 10 en o 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~