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COUNTY Dutchess
CITYITOWN Wappinqer
~~~~~c~ 1368
~0~1~;~R 27
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
M~tthew Benjamin Lindell
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Diana Marie Rossetti
MIDDLE CURRENT SURNAME
1 . A FULL NAME
11. A. FUll NAME
FIRST
FIRST
a.
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Lindell
(OPTIONAL. SEE REVERSE)07 8 5358
D. SOCIAL SECURITY NUMBER 4-6 -
12. RESIDENCE A. NY B Dutchess
(STAT.!') (COUNTY)
C CHECK ONE '!':J CITY 0 TOWN 0 VILLAGE
~~~CIFY Beacon
D. STREET ADDRESS 24 Crossway Road ZIP 12508
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? tj YES 0 NO
/40 /1'982
DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 133-66- 2156
2. RESIDENCE A. NY B. Albany
(STATE) (COUNTY)
C CHECK ONE ..tJ CITY 0 TOWN 0 VILLAGE
~~~CIFY Albany
D STREET ADDRESS 130 Western Avenue ZIP 12009
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES -6 NO
01 / 1? /1982
MONTH DAY YEAR
38. DATE OF BIRTH
09
MONTH
13. A. AGE 25
3. A. AGE ?6
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Rf>~rlJiter
8. TYPE OF INDUSTRY OR BUSINESS United States Army
5 PLACE OF BIRTH Citv Of Albanv, New York
(Clrt STATE / COUNTRY iF NOT USA)
6. FATHER
A. NAME Rnn~lrl Renj~min I indell
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Carole Ann Halleck
8. COUNTRY OF BIRTH LJ S A
8, NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
14. EMPLOYMENT
A USUAL OCCUPATION Self Emp:oyed
8. TYPE OF INDUSTRY OR BUSINESS Marketinq
15. PLACE OF BIRTH City Of Poughkeepsie, New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Francis Paul Rossetti
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Helen Katherine Honey
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
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8. HOW DID LAST MARRIAGE END? (3) r!I DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C, DATE LAST MARRIAGE ENDED? 01 / ~ 1 / ?008 c. DATE LAST MARRIAGE ENDED? / (.
MONTH DAY YEAR MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ['!"'yES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
1D. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1 ST 0 1/~ 11?00R C:;n~hen New Y nrk ~ 0 1 ST 0 0
,
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I duly swear/affirm, deRose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the marr tate,~
\.Q~~K.~
USE CURRENT NAME
21. SIGNATURE OF GROOM~
22. SIGNATURE OF BRIDE ~
E ~.(-/7~
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE 'E
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
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
DATE
04/09/2008
by New York Domestic
~
{ SEAL }
'-.t-I
NAME (PRINT)
YEAR
MONTH
YEAR
TIME
MONTH
AM
12:19PM
04
10
2008
10
06 2008
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
1~L
28. PLACE WHERE MARRIAGE OCCURRED
A, STATE NEW YORK B. COUNTYLt W'~<;('
C. LOCATION OF CEREMONY
(CHECK ONE AND ~ECIFY)
o CITY OF ~WN OF 0 VILLAGE OF
SPECIFY (U ~~f \ ",JOt j) V