107
SE CU ENT
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State of and groom named above by any person authorized by New York Domestic
W Relations Law ~11 to perform marriage ceremonies within New York te. THIS LICENSE VALID IN NEW YORK STATE ONLY.
en 0 If checked. this license is to be used only for the pu e of a second or subsequent ceremony.
Z ~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
W } NAME (PRINT) Jo C. Maste son
~ {SEAL SIGNATURE ~. DATE 08/30/2007 TIME MONTH YEAR MONTH
'- -.J MA~rr~8m~ appingers Falls, NY 12590 AM 08 31 2007 10 29 2007
-yo- 03:35PM
CITY/TOWN STATE ZIP
26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
TIME MO. AY YEAR 0 ~GIOUS
Y'1 t? 7 9 0 OTHER, SPECIFY
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FIRST 1~1~~r Phillip .IJd1tENT SURNAME
COUNTY Dutchess
CITYITOWN Wappinger
~~.:~ 1368 .
~5~:J~R 1 07
1. A. FULL NAME
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B. BIRTH NAME, IF OIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 114 74 1747'
D. SOCIAL SECURITY NUMBER _ _ _ - __ - _ ___
2. RESIDENCEA. NY B. nlltr.hp.~~
(STATE) (COUNTY)
C. CHECK ONE D CITY.zJ TOWN D VILLAGE
AND P hk .
SPECIFY nllg eepsle
D. STREET ADDRESS 22 Hampton Road ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? D YES ~ NO
3. A AGE 29 3B. DATE OF BIRTH Ofl /?? /1 q7R
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Wapp. Ctrl. Sch. Dist.
5. PLACE OF BIRTH Bronx, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME William Frlwin ./tltt
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Arlene Mary Ann Kenny
B. COUNTRY OF BIRTH U S A
8. NUMBER OF THIS MARF,lIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL-ANNUbMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) D ANNULMENT
/ /
(2) D DEATli
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MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10, IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATElCOUNTRY. IF NOT USA) SELF SPOUSE
o
o
D
.JI/rr
SIGNATURE~
OOH-98 (0312006)
I
STATE FILE NUMBER
(TH/S SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Carla Ann Del Treste
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. 81RTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE nP.1 T re~te - .llltt
(OPTIONAL - SEE REVERSE)119 64 0234
D. SOCIAL SECURITY NUMBER --
12. RESIDENCEA.NY B.Dlltchess
(STATE) (COUNTY)
C. CHECK ONE D CITY 'lI TOWN D VILLAGE
AND W .
SPECIFY applnger
D. STREET ADDRESs22 Orchard Drive
ZIP 12590
DYES tJ NO
.%981
YEAR
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILlAGE?
13. A. AGE ?fl 3B. DATE OF BIRTH 03 /22
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Dut.Comm. Colleqe
15. PLACE OF BIRTH Yonkers. New York
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Rossano Del Treste
'B. COUNTRY OF BIRTHltaly
17. MOTHER
A. MAIDEN NAME Nancy Ann Nehrebecki
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
(3) D ANNULMENT (2) D DEATH
/ /
.'~ YEAR
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES D NO
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY. STATElCOUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
D
D
o
YEAR
10 CIVIL
28. PLACE WHERE MARRIAGE OC"~ /
A. STATE NEW YORK B.~~~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ OF D VILLAGE OF
SPECIFY~ .,
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