177
D D 1ST D D
D D ~D D D
D D 3RD D D
D D 4TH D D
.e be);Of my ~wledge and belief that the information I provided is true and that I declare that no legal impediment exists
1::l ""- 22, SIGNATURE OF BRIDE~ ~ ~ Q. L...L-
us RENT NAME USE CURRENT NAME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE M 11/08/2006
SIGNATURE OF TOWN OR CIlY CLERK ~ DATE
This license authorizes the marriage in New the bride and groom named above by any person authorized by New York Domestic
W Relations Law ~11 to perform marriage ceremonie Within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
en D If checked, this license is to be used only for the urpose of a second or subsequent ceremony.
Z ~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
W } NAME (PRINT) John C. Ma~ '
~ {SEAL SIGNATURE ~ aJz- e b"'~ DATE 11/08/200 TIME MONTH
'-v-' MAILI~1t~ra~~~h Rd,tWappinger Falls, NY 12590 05:0~~ 11
STREET CIlY/TOWN STATE ZIP
~~iR~~R~~~ IO~?~~N:.zEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. AY YEAR 0 [ RELIGIOUS
DATE AND AT THE TIME AND ").":\ AM I I I Z'~'"
PLACE INDICATED. L' uIJ L ~ 9 OTHER, SPECIFY
29. OFFICIANT 1'^ ., \D'S l '-.w \ V" (2D I J
NAME (PRINT) _ VV" .... . L.() cJ TITLE 'V" .
t1J. A e. 2i. ..p j DATE t\ / II/Or"
~~~~1i'~~tESS f ~ 0- U f-
STREET CITYrrOWN
30. WITNESS TO~CERE N.~.
NAME (PRINT) . erJ.."!hf/ Lt, (
SIGNATURE~ ~Q
OOH-96 (03/2006)
+
!z
W
Ul
W
'"
9
5
:I:
Ul
Z
o
i
....
Ul
c;
W
a:
W
~
it
a:
<
~
...
o
~
U
i!
~
W
U
W
a:
W
~
Ul
Ul
W
a:
o
o
<
1::
o
W
Q.
Ul
Z
Q
Z
<
tu
w
~
+
~~~ W
?~"'
~ " ~ ....
~~~ C(J
::lUW
~C!li5 ~
!z~0l -
~~l5 t:
!tOUl W
0....>
wlll1!l (J
biD'"
zg~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
RnhArt Thnm;:)~ I AnnA
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYrrOWN WappinQer
~~.:~: 1368 .
~~~~~R 177
1. A. FULL NAME
FIRST
0..
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 062-74-8860
D. SOCiAl SECURITY NUMBER ___ __
2. RESIDENCEA. NAW York B, Dutchess
(STATE) (COUNTY)
C. CHECK ONE D CITY 01 TOWN D VILLAGE
AND W .
SPECIFY applnger
D. STREET ADDRESS 17D Alpine Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES cY' NO
3. A. AGE ?~ 3B. DATE OF BiRTH 03 / 25 / 198
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Manager
B. TYPE OF INDUSTRY OR BUSINESS Restaurant Industrv
5. PLACE OF BIRTH Carmel. New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Robert Eugene Leone
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Carol Marie Hall
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. ~~~~~~~R~~~8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) D ANNULMENT
/ /
(2) D DEATH
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
1 D. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CIlYICOUNTY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
YEAR
STATE
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Rachel Elizabeth Bell
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Leone
(OPTIONAL - SEE REVERSE) 114 72 7574
D. SOCIAL SECURITY NUMBER --
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE D CITY O"'TOWN D VILLAGE
~~~CIFY WappinQer
D. STREET ADDRESS 17D Alpine Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES d NO
13. A. AGE 26 3B. DATE OF BIRTH 10 / 17 /1980
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Wappinger Central
15. PLACE OF BIRTH NewburQh, New York
(CIlY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Robert Allen Bell
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Sandra Griffith
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
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D NO
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CI'TYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
(3) D ANNULMENT (2) D DEATH
/ /
.. '. - YEAR
YEAR
1 D CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY U b-te.r
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF ~ TOWN OF D VILLAGE OF
SPECIFY MCl,lbo(~
NAME (PRINT)
SIGNATURE~