049
+
!z
w
en
w
'" '
o
-'
:::>
o
I
en
z
o
g
en
a
w
a:
w
Cl
<
0;'
a:
<
::E.
u.
o
w
...
<.
t.l
i:i:
~
w
t.l
w
a:
w
~
en
en
w
a:
o
o
<
it
o
W
0-
en
rr.'
~
:::>
Z
c
~
Iii
w
rr.
In
+
~:I:Z W
~t::Q
ws:~ ~
~ffiz c:c
gs c3 ~ (.)
::EClc5 u:
....zen _
~~~ ~
[oen W
~~~ (.)
~~Lt)
ol'!
z:;~
COUNTY Dutchess
CITYrrOWN Wappinger
~~~~~ 1368 '
~~~I~l~R 49
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
P;:!tr~g~LE George ~~R~WSURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
1. A. FULL NAME
11. A. FULL NAME
SUPPLEMENTAL FILE
FROM THE BRIDE
Linda Kathleen Contratti
MIDDLE CURRENT'SURNAME
~
Lo
FIRST
FIRST
0-
N
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Kenny
(OPTIONAL - SEE REVERSE) 090 50 5472
D. SOCIAL SECURITY NUMBER --
12. RESIDENCEA. New York B Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 1!1 TOWN 0 VILLAGE
~~~CIFY Pouahkeepsie
D. STREET ADDRESS 7 Mainetti Drive ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY DR INCORPORATED VILLAGE? 0 YES tJ NO
12 /11 /1'968
MONTH DAY YEAR
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL, SEE REVERSE)
D. SOCIAL SECURITY NUMBER 106-64-9430
2. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND P hk .
SPECIFY oug eepsle
D STREET ADDRESS 7 Mainetti Drive ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES tJ NO
3. A. AGE 41 3B. DATE OF BIRTH 09 / 03 / 1965
MONTH DAY YEAR
3B. DATE OF BIRTH
13. A. AGE 38
4. EMPLOYMENT
A. USUAL OCCUPATION Desig n er
B. TYPE OF INDUSTRY OR BUSINESS L J Gonzer Assoc.
5. PLACE OF BIRTH Smithtown. New York
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Patrick George Kenny
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Ernestine Iovino
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
14. EMPLOYMENT
A. USUAL OCCUPATION Procurement Professional
B. TYPE OF INDUSTRY OR BUSINESS I. B. M.
15. PLACE OF BIRTH PouQhkeepsie, New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Frank Contratti
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Katherine Otterbach
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES 19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH DIVORCE CIVIL ANNULMENT DEATH
1 0 0 1 0 0
B. HOW DID LAST MARRIAGE END? (3) t5 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) r5 DIVORCE (3) 0 ANNULMENT (9~ DEATH
c. DATE LAST MARRIAGE ENDED? 09 / 26 / 2000' C. DATE LAST MARRIAGE ENDED? 02 / 14 / 19
MONT'1,.o DAY YEAR MONTtU DAY, . - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? [JYES 0 NO D. ARE ANY FORMER SPOLlSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED. PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNUL:LE-o; PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITYICOUNTY. STATElCOUNTRY, IF NOT USA) SELF SPOUSE (MONTH. DAY. YEAR) (CITY/COUNTY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST 09/26/2000 Poughkeepsie, New York 0 r:1 1ST 02/14/1996 Poughkeepsje, New York rf
2ND 0 0 2ND
3RD 0 0 3RD
~: 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
as to my right to enter into the age tat .
21. SIGNATURE OF GROOM ~ 22. SIGN URE OF BRIDE ~
SEC R
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
DATE
w
en
z
w
(.)
::::;
This Iitense authorizes the marriage in New York State of th authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New York S e. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for the purpose of a seoonCll or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Jo C. Mast rson
{SEAL SIGNATURE ~. DATE 06/13/2007 TIME MONTH YEAR MONTH
\.- -.J MAI~ ItIlf8~eb appinger Falls, NY 12590 AM 06 14 2007 08 12 2007
-v- 03 :46PM
STREET CITYITOWN STATE ZIP
~~~R~:RT~~~ IO~O~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~
SONS NAMED ABOVE ON THE TIME M DAY YEAR 0 0 RELIGIOUS 1 IVIL
OATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER. SPECIFY
YEAR
26. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY \) Ii tcl.t <;.1)
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY ~ov,\ ~ ~~\-P
NAME (PRINT)
SIGNATURE~