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COUNTY Dutchess
CITYrrOWN Wappinaer
~~~:~c: 1368 '
~5~~l~R 44
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
r.hri~t9cil~er .John ~~fei1r'ru~NAME
I
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Allison Elizabeth Morton
MIDDLE CURRENT SURNAME
~
1 , A, FULL NAME
11, A. FULL NAME
FIRST
FIRST
B. BIRTH NAME, IF DIFFERENT B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE C. SURNAME AFTER MARRIAGE La F alee
(OPTIONAL - SEE REVERSE) 134 58 6455 (OPTIONAL - SEE REVERSE) 066 74 0749
D. SOCIAL SECURITY NUMBER - - D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess 12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY) (STATE) (COUNTY)
C. CHECK ONE 0 CITY il'I TOWN 0 VilLAGE C, CHECK ONE 0 CITY r!f TOWN 0 VilLAGE
AND P hk . AND P hk .
SPECIFY oug eepsle SPECIFY oua eepsle
D. STREET ADDRESS 24 Streit Avenue; Apt 1 ZIP 12603 D. STREET ADDRESS 24 Streit Avenue; Apt 1 ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3. A. AGE ~5 3B. DATE OF BiRTH 05 / 12 / 1972 13. A. AGE 24 3B. DATE OF BIRTH 08 /17 /f 982
MONTH DAY YEAR MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Metal Fabrication
B. TYPE OF INDUSTRY OR BUSINESS Manufacturina
5. PLACE OF BIRTH Lancaster. California
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Richard Anthony LaFalce
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Barbara Ann Scarchilli
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. ~~~~~~~RM6'FR~I{'e~~gus MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION Stay At Home Mom
B. TYPE OF INDUSTRY OR BUSINESS
15. Pt!ACE OF BIRTH Pouahkeepsie, New York
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Thomas Lloyd Morton
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Innes Elizabeth Potter
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
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(3) 0 ANNULMENT (2) 0 DEATH
/ /
...- YEAR
(2) 0 DEATH
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) (CITY/COUNTY, STATElCOUNTAY, IF NOT USA) SELF SPOUSE
YEAR
MONTH DAY
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
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/aftinn, aep'ose and at to the best of my knowledge and belief that the infonnation I provided is true and that I declare that no legal impediment exists
as to my right to enter into the m estate. ~
21. SIGNATURE OF GROOM~ . USE RR 22. SIGNATURE OF BRIDE~ ~ U~AMU__
23. ~::~~=~DO~~~~OJ'~ ci~~r~~:~ BEFORE ME l DATE 06/01/2007
This license authorizes the marriage in NewY by New York Domestic
W Relations Law ~11 to perfonn marriage ceremonies in New York State. 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. SOLlEMNIZATION PERIOD BEGINS
W } NAME (PRINT) J C. Masterson
(,) { /01/ TIME MONTH YEAR MONTH
:::::i SEAL SIGNATURE. DATE 06 200
"-- -.J MAII.lNG 'QDI'I'\~$,S AM 2 200 07 31 2007
-v- LU MlaalE appinger Falls, NY 12590 03:54PM 06 0 7
STREET ClTYrroWN STATE ZIP
~~~R~~RT~~J 'o~O~~N~1f~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME AY YEAR 0 pa RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 07 90 OTHER, SPECIFY
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVil
A. STATE NEW YORK B. COUNTY
'[)t./( 0'"
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFYC '5c.~~
29. OFFICIANT r r n '\L "" ,
NAME (PRINT) l7""l: IC..M U '-> .
SIGNATURE. Jr. ,01_ Q,J... !) ~
MAILING ADORE!!;
735 lAYtoN ~~
STREET CITY/TOWN
30. WITNESS TO CEREMO. NY S h.....Y'Of
NAME (PRINT) ~_
SIGNATURE. ~ .
DOH-98 (0312006)
REv:
6(111 07
(
c"LA RJ'-.
c4.L
TITLE
DATE
...s7A ^' ~O "0 Vft...'-'E.
NY
STATE
....
SIGNATURE.