145
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FIRST Vi~~~nt J. DiGi~~~L<?sURNAME
1ST 0 0 1ST
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 provid
as to my right to enter into th'\ ~friage state. ./ ....., . . ~
21. SIGNATURE OF GROOM~ V.~ d . 22. SIGNATURE OF BRID
USE CU ENT NAME L J ~
23. ~~e::~~~Do~.fo~~OJ'~ri~A5r:r~KE~ BEFORE M '---<" 1k~' ., f".( -
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY pL RK C M t n 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) J( n . as erso
{SEAL} SIGNATURE~
MAIL~e
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COUNTY Dutchess
CITYrrOWN Wappinger
~~;:~ 1368 .
~G~I:~R 145
1. A. FUll. NAME
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B. BIRTH NAME, IF DIFFERENT
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C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 126-34-2670
D. SOCIAL SECURITY NUMBER
2. RESIDENCEA. New York B. Westchester
(STATE) (COUN1Y)
C. CHECK ONE 0 CITY [!" TOWN 0 VILLAGE
~~CIFY Yorktown
D. STREET ADDRESS 3747 Briar Hill Street
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ZIP 10547
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
09 / 06 / 1944
MONTH DAY YEAR
3. A. AGE 62
3B. DATE OF BiRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Retired
B. TYPE OF INDUSTRY OR BUSINESS
5. PLACE OF BIRTH Bronx, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Vincent DiGioroio
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Frances Panepinto
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARF,lIAGE 2
9. ~~~~~~~RM6FR~If~~8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEAr
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(~o DEATH
2u04 .
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B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 07/ 28 /
MONTH iJ!.Y 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
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Edith Cenname
MIDDLE CURRENT SURNAME
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11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE DiGioraio
(OPTIONAL. SEE REVERSE) 112-46-2809
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Westchester
(STATE) (COUN1Y)
C. CHECK ONE 0 CITY D'" TOWN 0 VilLAGE
~~~CIFY Yorktown
D. STREET ADDRESS 3747 Briar Hill Street ZIP 10547
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
03 /14 /1951
DAY YEAR
13. A. AGE 55
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Credit Manager
B. TYPE OF INDUSTRY OR BUSINESS Endico Potatoes, Inc.
15. PLACE OF BIRTH Mount Vernon, New York
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Frank Josegh Cenname
. B. COUNTRY OF BIRTH U A
17. MOTHER
A. MAIDEN NAME Sadie Theresa Toto
B. COUNTRY OF BIRTH U S ~
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL ANN~LMENT DEAfH
.,
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCO (3) 0 d~ULMENT o26~ DEATH
c. DATE LAST MARRIAGE ENDED? 7 / / 2
MONTH l/1A Y . - - YEAR
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) (CITYICOUN1Y. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
o 0
o 0
o 0
o 0
that no legal impediment exists
09/11/2006
DATE
by New York Domestic
TIME
MONTH
YEAR
MONTH
YEAR
09/11/200
DATE
appinger Falls, NY 12590
01 :o~~
09
12
2006
11
10 2006
+
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
ZIP
1~
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COU~
C. LOCATION OF CEREMONY
(CHECK ONE AN~CIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY~MT1' $"-JC.~~c...
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NAME (PRINT)
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NAME (PRINT)
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