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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FIRST Andre'^6lfotpnk Crisr~d~~~s'uIfNAME
COUNTY Dutchess
CITYfTOWN Wappinger
~~~~~c~ 1368
~~~I~~~R 29
1. A. FULL NAME
"'-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 044-RO-O 141
2. RESIDENCE A.-C:fsTATE) B ~~J;1a\len
C. CHECK ONE 0 CITY ollI TOWN 0 VILLAGE
AND
SPECIFY Rr~nfnrrl
o STREET ADDRESS 1 9 Patrick Lane ZIP 06405
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES tl NO
MO~J / 01; / yllt57
3. A. AGE 50
4. EMPLOYMENT
A USUAL OCCUPATION Engineer
B. TYPE OF INDUSTRY OR BUSINESS Aprn~r::lr:p
5. PLACE OF BIRTH Nel,t\/ H::l\lpn CT
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A NAME Andr~\A1 Frank Criscl.lolo
B. COUNTRY OF BIRTH I I S A
3B. DATE OF BIRTH
7. MOTHER
A. MAIDEN NAME Catherine Ann n~ne~p
B. COUNTRY OF BIRTH I I S A
8, NUMBER OF THIS MARRIAGE ?
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
1
o
B. HOW DID LAST MARRIAGE END? (3) IS1\" DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 03/ 15 / ?n07 '
MONTH DA~ vrA~
D. ARE ANY FORMER SPOUSE(S) ALIVE? CY"i'ES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Maria Georgievna I IJkianoff
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE r.ri~r:llnln
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUM8ER 077 -70-1343
12. RESIDENCE A. r.T B. New H::lven
(STATE) (COUNTY)
C. CHECK ONE i"I CITY 0 TOWN 0 VILLAGE
AND Db
SPECIFY e r y
D. STREET ADDRESS 273 Derby Avenue 908 ZIP 06418
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
/?Fi A q74
DAY YEAR
13. A. AGE 34
3B. DATE OF BIRTH
O?
MONTH
14. EMPLOYMENT
A, USUAL OCCUPATION Fnginepr
B. TYPE OF INDUSTRY OR BUSINESS Aerospace
15. PLACE OF BIRTH ~1~~~TA*J;l~~~FlY ~~T'USA)
16. FATHER
A. NAME ~eorop \/~~ilipvir.h
'B. COUNTRY OF BIRTH Yugoslavia
17. MOTHER
A. MAIDEN NAME T::Iti;m::l Andreevna Tenson
B. COUNTRY OF BIRTH Gp.rmany
18. NUMBER OF THIS MARRIAGE 1
19, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
o
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
1ST 03/15/2007 Middletown, CT 0 ~ 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I duly swe!lr/affirm, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no le~1 impediment exists
as to my right to enter Into the m~e..J~ .-t... ~~_ /-~:;. ~
21.SIGNATUREOFGROOM~ ~~_ .22.SIGNATUREOFBRIDE~' ~p
U~CURRENT NA~ /c-- U ENT NAME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFOI'll!-ME1 " J .11 ....., "-
SIGNATUREOFTOWNORCITYCLERK~ ~__D!!c __~~ DATE_ _
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 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
~
{ SEAL }
'-..-I
NAME (PRINT)
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
TIME
MONTH
YEAR
MONTH
YEAR
AM
03:20PM
04
2008
15
06
13 2008
A
27. TYPE OF CEREMONY
o g RELIGIOUS
OTHER, SPECIFY
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY /( If) {: It Ift?1 (
/}rcApr/~.J I-
DATE 0 '-/F-.;Loog
p(\..; /0977
STATE liP
31. WITNESS TO CEREMONY
NAME (PRINT) jOS6I I
SIGNATURE ..
MAillS-' APJ E
STREET
30. WITNESS TO CEREMONY
NAME (PRINT) N A 111 St-\ A
SIGNATURE~~
DOH-98 (0312006)
v.
\..J
KOtVOtJ
ci--
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~TOWN OF 0 VILLAGE OF
SPECIFY C ~ t2 r f .J fo w n
SIGNATURE~