040
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COUNTY Dutchess
CITYfTOWN WappinQer
2~~:~c~ 1368
~~~~;~R 40
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
George Ban
MIDDLE CURRENT SURNAME
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Patricia Ann Battista
MIDDLE CURRENT SURNAME
~
1 . A. FULL NAME
11. A FULL NAME
FIRST
FIRST
ll.
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Ban
(OPTIONAL. SEE REVERSE) 115 42 2784
D. SOCIAL SECURITY NUMBER --
12 RESIDENCE A, NY B. Dutchess
(ST ATE) (COUNTY)
C CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W '
SPECIFY appmqer
D STREET ADDRESS 51 0 Maloney Rd.; Apt 88
B. BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)499 52 7525
D. SOCIAL SECURITY NUMBER --
2 RESIDENCE A. NY B Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY otJ TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D STREET ADDRESS 510 Malonev Rd.; Apt S8 ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES '6 NO
04 /?4 /1949
MONTH DAY YEAR
ZIP 12603
DYES tJ NO
/1'950
YEAR
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13 A AGE 57 3B. DATE OF BIRTH 12 /4 9
MONTH DAY
3. A AGE !)!=l
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Sales Manager
B. TYPE OF INDUSTRY OR BUSINESS Publishing
5. PLACE OF BIRTH Budapest Hungary
(CITY, STATE / COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION IBM
B. TYPE OF INDUSTRY OR BUSINESS Computer
15. PLACE OF BIRTH Pouohkeepsie, New York
(CITY , STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Frnn Ran
B. COUNTRY OF BIRTH Hungary
7. MOTHER
A. MAIDEN NAME Noemi Gabor
B. COUNTRY OF BIRTH Hungary
8. NUMBER OF THIS MARRIAGE 2
16. FATHER
A. NAME Daniel Battista
'8. COUNTRY OF BIRTH U 8 A
17. MOTHER
A. MAIDEN NAME Ethel Lee Koppel
B. COUNTRY OF BIRTH U 8 A
18. NUMBER OF THIS MARRIAGE 2
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SIGNATURE~
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19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C, DATE LAST MARRIAGE ENDED? 09 / 20 / 1982
MONTH DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~YES 0 NO
~
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
09/20/1982 Dutchess County. New 0 1!1'
o 0
o 0
o 0
that I declare that no legal impediment ~xists
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3)1!1' DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 1 ? / ?? /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? ['!"yES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20.
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1?/??/19!=l!=l Rnr:kland CnLJnty, New ~ 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
dge and belief that the information I provided is tru
DEATH
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(2) 0 DEATH
1!=l99
YEAR
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say, th
as to my right to enter into the mama
22. SIGNATURE OF BRIDE ~
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23. SUBSCRIBED AND SWORN AFFIRMED BEFO
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 !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
04/30/2008
DATE
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
~
{ SEAL }
'-y-I
NAME (PRINT)
MONTH
DAY
YEAR
YEAR
TIME
MONTH
AM
06:21 PM
29 2008
2008
06
05
01
28. PLACE WHERE MARRIAGE OCCU~
A. STATE NEW YORK B. COUN C J4..
C, LOCATION OF CEREMONY
(CHECK ONE AN~CIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY t"~r ~L.s J... t:..: LL
NAME (PRINT)
SIGNATURE~ .
n,",u~aA In'lf..,nn~\