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COUNTY Dutchess
CITYfTOWN Wappinger
~~J:kc; 1368 '
~5~~~~R 125
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFADAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseoh W. Girolamo
MIDDLE CURRENT SURNAME
FIRST
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Wilhelmina Doellmann
MIDDLE CURRENT SURNAME
1 , A. FULL NAME
1 1, A, FULL NAME
FIRST
ll.
N
B, BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE G i rala mo
(OPTIONAL - SEE REVERSE) 057 -50-6813
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. NY B. Sullivan
(STATE)..J (COUNTY)
C, CHECK ONE 0 CITY CJ TOWN 0 VILLAGE
~~~CIFY ThomQson
o STREET ADDRESS 808 St. Rte 17 B ZIf' 12701
Mont1ce~~o ~
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES U NO
13. A. AGE 50 3B. DATE OF BIRTH 04 /25 ;f956
MONTH DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 069-34-5481
D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C, CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 9 Mac I ntosh Lane ZIf' 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
03 / 29 / 1942
MONTH DAY YEAR
3. A. AGE 64
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Retired
B. TYPE OF INDUSTRY OR BUSINESS
5. PLACE OF BIRTH Manhattan, New York
(CITY, STATE I COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Legal secreta~
B. TYPE OF INDUSTRY OR BUSINESS Edwar M. Cooke, Esq.
15. PLACE OF BIRTH Queens, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Unknown
B. COUNTRY OF BIRTH USA
16. FATHER
A. NAME Frank Doellman
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Irene Schub
B. COUNTRY OF BIRTH USA
1
1B. NUMBER OF THIS MARRIAGE
7. MOTHER
A. MAIDEN NAME Geraldine Girolamo
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) o'DIVORCE (3) 0 ANNULMENT 1 ~ff6DEAJH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 01 / 30 / C. DATE LAST MARRIAGE ENDED? / /
MONTH..... DAY YEAR MONTH DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(~ONTI;l. R"'Y1 rEA'll (CITY/CPUfITY. STATE/COUlfTflVI NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST u1/;JUI ~~b PougnKeepsle, N 0 r5 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I duly swear/affirm. depose and knowledge and belief that the information I prOVidedjJi'S e.and that I declate that no lega 'mpediment exists
as to my right to enter into th
21. SIGNATURE OF GROOM~ 22 SIGNATURE OF IiIRIDE ~
USE CU L. ~ USE CURRENT NAME
23, SUBSCRIBED AND SWORN TO/AFFi MED BEFO E ME . 08i15/2006
SIGNATUREOFTOWNIOF\ICITYC RK~ ,~ ~ '~I< - J 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 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 CI1J8lf~K, 25, A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) .
DE~H
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DI(j'RCE CIVIL AN~ULMENT
DE~TH
~
{ SEAL }
'-v-'
YEAR
SIGNATURE ~
MAI2"6' M~B'I~b
10
14 2006
STREET CITYITOWN STATE
~~~R~:RT~t~ ~~O~~N~~E~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M. DAY YEAR 0 ~ELlGIOUS
DATE AND AT THE TIME AND AM
PLACE INDICATED, 3 10 0 I J<oet 9 0 OTHER, SPECIFY
~~~n~~~ RfV, /J(~vR. .J Offt> J FA eL.E t TITLE ellT>+oLl c .p~ JeST
SIGNATURE~ ~ i. J~ DATE Ocr /} 2otJt-
MpIO~ ~~~stltfz 8 {(Sf: ~\..l.lrn6A ~H"ec)l) rhPEI,IJ ~t.L Jl(NC-7iJ)P' AJY
STREET t CITYfTOWN STATE (z.r - 3 ZIP
30. WITNESS TO CEREMONY 31. WITNESS TO CEREMONY iJ
NAME (PRINT) C NAME (PRINT) -rt-l-L (! f
ZIP
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY }) /lIe H-fs5
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF X'TOWN OF 0 VILLAGE OF
SPECIFY &ST F: s HI</ t.... L
SIGNATURE~
,.rll
SIGNATURE~