054
+
a
(j)
L()
N
~
w
~S
0"
>-
3:
Q)
z ~
fficn s:
.,- CC
ll:ro c
gLL _
::lcnt\lu..
~~~u..
VJQ)-CC
~ c: ~
~'-g
tii ro 5
~~
w
C!l
~Q)
~.~
<~
~o
0-0
~o
uO
l!;::
li:Q)
~cn
w
0:
w
~
VJ
VJ
W
0:
C
C
<
~
l5
w
"-
VJ
w
-tJ)
Z
-w
o
-:i
+
~~~ w
t~~ !:::
o:l<:N _
tii~~ 0
::lUW
:l:C!lc5 u::
!z~VJ -
~~15 t:
lE~VJ w
~wg 0
~~~
z::;~
COUNTY Dutchess
CITYfTOWN WappinQer
~~~:~ 1368 .
~5~:J~R 54
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Russell James Sheckler
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
"""'"
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Tania Greco
MIDDLE CURRENT SURNAME
~
1. A. FULL NAME
1 L A. FULL NAME
FIRST
FIRST
0-
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSEl119_66_01 03
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANew York B.Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY WappinQer
D. STREET ADDRESS 125 Rosewood Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES tJ NO
13. A. AGE 38 3B. DATE OF BIRTH 10 /19 )'968
MONTH DAY YEAR
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE G reca
(OPTIONAL - SEE REVERSE)176 60 1216
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY..a TOWN 0 VILLAGE
~~~CIFY Wappinqer
D. STREET ADDRESS 125 Rosewood Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
11 /19 /1971
MONTH DAY YEAR
3. A. AGE 35
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION School Counselor
B. TYPE OF INDUSTRY OR BUSINESS Mount Pleasant Sch.
15. PLACE OF BIRTH Bronx. New York
(CITY. STATE I COUNTRY IF NOT USA)
4. EMPLOYMENT
A. USUAL OCCUPATION Maintenance Technician
B. TYPE OF INDUSTRY OR BUSINESS Rondout Bank
5. PLACE OF BIRTH Wilkes - Barre, Pennsylvania
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Benny Greco
. B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Pauline lalongo
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
6. FATHER
A. NAME Morris Sheckler
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Penelope Switlick
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. ~~~~~~~RMtf~~~T8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D'OORCE CIVIL A'()ULMENT
D~TH
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. '.~ YEAR
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
B. HOW 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 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 0 0 1ST 0 0
2ND 0 0 2ND 0 0
~ 0 0 ~ 0 0
4TH: 0 0 4TH 0 0
I duly swear/affirm, dep'ose 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 ma ge state. "-y
21. SIGNATURE OF GROOM~ RE OF BRIDE~ \.. ~J'7..;'~ (lA!:.:,q-
23. SUBSCRIBED AND SWORN TOIAFFI MED BEFORE ~~E CU E N USE CURRE AME 06/20/2007
SIGNATURE OF TOWN OR CITY CLERK ~ 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 S . THIS LICENSE VALID IN NEW YORK STATE ONLY.
. 0 If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) JO
YEAR MONTH
SEAL SIGNATURE ~
~ MA~[13~
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
YEAR
08
19 2007
CITY/TOWN
26. SOLEMNIZATION OCCURRED
TIME O. DAY YEAR
g.CIl> ':' I f.\
STATE
27. TYjE OF CEREMONY
o ~ RELIGIOUS
9 0 OTHER, SPECIFY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ""VILLAGE OF
SPECIFY 8R.t,.~XV\ L.t.$
ZIP
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYvJ~1ct+i:>'O'T~
10 CIVIL
29. OFFICIANT
NAME (PRINT)
Ct.l:hG v: - {?,C ,
7'11'1-107
NAME (PRINT)
SIGNATURE~
OOH-98 (03/20061