083
r
COUNTY Dutchess
CITYfTOWhJ Wappinger
~~,:~: 1368
. REGISTER 83
NUMBER
'* CORRCC1ID
STATE OF NEW VORl(
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
%CERTIFICA TE OF
oy O~~:~it\NTh 7 MARRIAGE
FROM THE G OOM
:: / ....p
~ ~U~P~:~E:T:::;I~~ ,1 ~ ~;~~f '~~
FROM THE BRIDE
.IO::lnnA VAr::l Orlik
MIDDLE CURRENT SURNAME
~~ij~~~~R~~~~8us 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? 01 / 10 / 2006
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~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
01/10/2006 Poughkeepsie, Ny 0 ~ 1ST
o 0 2ND
o 0 3RD
o 0 4TH
ge and belief that the info rmatlon I provided Is true
USE U
23. SUBSCRIBED AND SWORN TO/AFFIRM 0 BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage In New State of t bride and groom named above by any person authorized
Relations Law ~11 to perfonm marriage ceremonies W hln New York State. THIS LICENSE VAL.ID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for the u se of a second or subse uent ceremony.
r-"-.. 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) J C. Masterson
{SEAL SIGNATURE ~ ~ DATE 08/03/2007 TIME MONTH YEAR
'-.t-I MA~tffvWd'M 'sh Rd Wappinger Falls, NY 12590 03:08~~ 08 04 2007
STREET CITYITOWN STATE P
~~~R~~Ri:J IO~O~N~:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME DAY YEAR 0 il1 RELIGIOUS 1 0 CIVIL
W ~c.r~E ~~g.tA~~~E TIME AND ~ ~ /r AM O'g J (p 0 9 0 OTHER, SPECIFY
5 ~~:~~~~~Kell I<..ItWJ./J tfrru;n.tIseiV TITLE 7=/1te~ /J1/~/J
u:: SIGNATURE~;2 3' (l/tl.fe.f),'~"'~ "'JA. -;, ~ATE /l-l..Iqu-sT /6, 2iJo 1
~ MAl N~AD ES ':tw,&1ffJ . :u/.tUJ7;nt!, if A-~3
W STREET CITYfT WN STATE
(,) 30. WITNESS TO CEREMONY
FULL NAME
FIRST
I olli~ A~!hony "I('fl~'r
MID L U SURNAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 110-48-5813
2. RESIDENCE A. NY B. nlltr.hA~~
(STATE) (COUNTY)
f. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~CIFY Wappingers F::llIs
.. D. STREET ADDRESS 2530 South Avenue ZIP 12590
~ IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? P!!1 YES 0 NO
3 AGE ~Q 3B. DATE OF BIRTH OQ / 1 R /1 QR7
MONTH DAY YEAR
. MPLOYMENT
A. USUAL OCCUPATION DAtectivA
B. TYPE OF INDUSTRY OR BUSINESS Police Department
5. PLACE OF BIRTH Pouahkeeosie. Nv
(CITY. S'fATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME I olJis Anthony LIJ/':::lto Jr
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Viola R. lori
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
9.
DEATH
o
1ST
2ND
3RD
4TH
I duly swear/affinm, dep.ose and sa
as to my right to enter into the marr a
21. SIGNATURE OF GROOM ~ '
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NAME (PRINT)
SIGNATURE~
OOH-98 (0312006)
STATE FILE NUMBER
(TH/S SPACE FOR STA TE USE ONL YI
"I
1 1. A. FULL NAME
FIRST
B. BRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SJRNAME AFTER MARRIAGE I 11l':::ltO
D. ~:~~I1~;~U~EB~~RSE)064-72-4125
12. RESIDENCE A. NY B. I1llkhASS
(ST A TEl (COUNTY)
C. (HECK ONE 0 CITY 0 TOWN III VILLAGE
~~CIFY Wappingers Falls
D. STREET ADDREss2530 South Avenue ZIP 12590
E. IS RESIDENCE IIVITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
13. A. .IGE 3R 38. DATE OF BIRTH 03 ,..64 ;(971
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Social Worker
B. 1YPE OF INDUSTRY OR BUSINESS Social Services
15. PLACE OF BIRiH Bronx. Ny
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. fiA....,e Joseph Louis Orlik
. B. COUNTRY OF BIRTH USA
17. MOlHER
A. NAIDEN NAME AnQela Ann LaMonica
B. COUNTRY OF BIRTH USA
1 B. NUMlER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. IIIulilBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
B. 'rfJN DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
20. IF PRE"IOUSLYDIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MJNTH. DAY, YEAR) (CITY/COUNTY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
22. SIGNATURE OFBRIDE~
DATE
by New York Domestic
MONTH
YEAR
10
02 2007
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY$1~ :!
. LOCATION OF CEREMONY :J/~ c:
(CHECK ONE AND SPECIFY) ~C/.
o CITY OF X TOWN OF, ILLAG~ OF ~-t
SPECIFY J ~~JI. /.' fi"n\.,4,~I"'s},.yt n
). ~ p,q'J,1€LfI/,I j /~,f4)
31. Wrrt.I ESS TO CEREMOt.lY L
NAME (PFlINT) I ~ V
ZIP
SIGNAiUAE~
~q5~'1/07Jt
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August 22, 2007
Mr. Chris Masterson, Town Clerk
Town of Wappinger
20 Middlebush Road
Wappingers Falls, NY 12590
Dear Mr. Masterson,
I, Rev. Ralph J. Amundsen, performed the wedding of Louis Anthony Lucato,
Jr. and Joanne Vera Orlik on August 16, 2007 at 23 Ridgeview Road in the
Town of East Fishkill.
....
The location where the marriage occurred was entered incorrectly in Box 28
on the Marriage License. "Village of Hopewell Junction" was entered in Box
28, whereas, the "Town of East Fishkill," should have been entered.
Thank you for your help in correcting this error so that the couple will have a
official, correct Certificate of Marriage.
With blessings,
~e~ ~~ "":r. ~JL-
Rev. Ralph Amundsen
Registry:
City of New York
Marriage License Bureau
PSB98
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II~IISTATE OF NEW YORK
., DEPARTMENT OF HEALTH
Corning Tower
The Governor Nelson A. Rockefeller Empire State Plaza
Albany, New York 12237
September 14, 2007
Groom:
Bride:
Louis Anthony Lucato, Jr.
Joanne Vera Orlik
Dear Town/City Clerk:
Enclosed is a copy of the marriage referred to by the above file in your office.
Correction to the original has been made based on:
o Affidavit
~ Officiant's Statement
o Signature on original marriage affidavit
o Statement verified by City/Town Clerk
o Other: Supplemental
Please file this amended record along with the supporting documentation.
If you have any questions, please call us at (518) 486-3301.
Sincerely,
(J.QQJL) J7. L~ · ...)
Arleen Meres
New York State Dept. of Health
Vital Records Section
Marriage Registration Unit
P.O. Box 2602
Albany, NY 12220-2602
Enclosure
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23~~
CXopew.eU~~ cncy 12533
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August 22, 2007
Mr. Chris Masterson, Town Clerk
Town of Wappinger
20 Middlebush Road
Wappingers Falls, NY 12590
Dear Mr. Masterson,
I, Rev. Ralph J. Amundsen, performed the wedding of Louis Anthony Lucato,
Jr. and Joanne Vera Orlik on August 16, 2007 at 23 Ridgeview Road in the
Town of East Fishkill.
The location where the marriage occurred was entered incorrectly in Box 28
on the Marriage License. "Village of Hopewell Junction" was entered in Box
28, whereas, the "Town of East Fishkill," should have been entered.
Thank you for your help in correcting this error so that the couple will have a
official, correct Certificate of Marriage.
With blessings,
~e~ ~~ "'::r. j:\JL-
Rev. Ralph Amundsen
Reg istry:
City of New York
Marriage License Bureau
P5B98
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845-226-5267
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,
TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
JOSEPH RUGGIERO
TOWN CLERK'S OFFICE
20 MIDDlEBUSH ROAD
WAPPINGERS FAllS. NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
WilLIAM H. BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOlONI
Rev. Ralph J. Amundsen
23 Ridgeview Rd.
Hopewell Junction, NY 12533
Dear Rev. Ralph J. Amundsen,
My office has received the Marriage License for the marriaite of Louis Anthony Lucato, Jr.
and Joanne Vera Orlik, which you performed on August 18t ,2007. At the time oflicensing,
my office provided the couple with a memo that would assist you in the completion of block
#28. The information that you entered into block #28 is incorrect. There is no Village of
Hopewell Junction. The entry should have read "Town of East Fishkill".
I am enclosing a DOH-1827: Affidavit for Correction of Marriage License. The affidavit
"must be signed by both the husband and wife in the presence of a notary public".
Documentation is also required to make corrections to the Marriage License. In this case,
sufficient documentation is:
. a letter from the officiant, on official letterhead, or
. a certified copy of the officiant's record, or
. a Church Certificate with seal
Please mail the affidavit and documentation to my office at your earliest convenience.
cc: Louis Anthony Lucato, Jr.
Joanne Vera Orlik
Enc.
-