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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FIRST Cha~!~~ Anthony c~S!~~~~NAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
COUNTY Dutchess
CITYfroWN Wappinger
~~~:~c: 1368 .
~~~I:~~R 119
~
L D SUPPLEMENTAL FILE
FROM THE BRIDE
CarolAnne Stephens
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Di Napoli
c. SURNAME AFTER MARRIAGE Stephens
(OPTIONAL' SEE REVERSE) 058-66-3445
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 01 TOWN 0 VILLAGE
AND W '
D. ::~~ ADDRE:P~~~~ld Route 9 N ~P 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
10 /22 /1965
MONTH DAY YEAR
11. A. FULL NAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 068-70-4285
D. SOCIAL SECURITY NUMBER
2. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY cY' TOWN 0 VILLAGE
;~CIFY Wappinqer
D. STREET ADDRESS 756 Old Route 9 N
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES Lf NO
12 / 07 / 196
MONTH DAY YEAR
13. A. AGE 40
3B. DATE OF BIRTH
3. A. AGE 37
3B. DATE OF BiRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Administrative Manager
B. TYPE OF INDUSTRY OR BUSINESS Europa ASSOCiates
15. PLACE OF BIRTH Brooklyn, New York
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Pasquale Di Napoli
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Joan Isabelle Stewart Wood
B. COUNTRY OF BIRTH USA
;:3
18. NUMBER OF THIS MARRIAGE
4. EMPLOYMENT
A. USUAL OCCUPATION Correction Officer
B. TYPE OF INDUSTRY OR BUSINESS NYS DOCS
5. PLACEOFBIRTH PQugh~eepsie, New York
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Charles Michael Straley
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Regina Eleanor Secor
B. COUNTRY OF BIRTH USA
3
8. NUMBER OF THIS MAR81AGE
9. PREVIOUS MARRIAGES 19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO'2E CIVIL ANNOLMENT DEA~ DIV~RCE CIVIL ANN~LMENT DE"Cr
~ ~
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT 2(5Q~EATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCb (3) 0 ~LMENT 2~QJ4DEATH
C. DATE LAST MARRIAGE ENDED? 1 Q/ 23 / C. DATE LAST MARRIAGE ENDED? 4 / /
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
(MONTH, DAYr YEAR) ...lCITYICOUNTY, STATElCOUNT.R)'. IF NOJ }lSA) SELF SPOUSE (M~/H, ~l' Y~ p(CITY/Cqu~. STATE/POUNlIlY, IF NQT,USAl. SELF SPOUSE
1ST 02/021999 jJoughkeepsie, New york o~ 0 1ST lU 1u.1~~( QugnKeepsle, l'\Iew YOrK 0 oil'
2ND lU1~;:3/~UUl jJougnKeepsle, New YorK O~ 0 2ND U4/~f/~004 jJQughkeepsle, New york 0 Oil
~ 0 0 ~ 0 0
4TH 0 0 4TH 0 0
I duly swear/affinn, dep'ose and say, that to the best of my wi dge and belief that the infonnation I provided is true and that I declare that no I al impediment exists
as to my right to enter into the m n state.
21. SIGNATURE OF GROOM~ (>. 22. SIGNATURE OF BRIDE~
us
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New Drk State of the bride: and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perfonn 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 J8h'A C. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
08/09/200 TIME MONTH YEAR MONTH DAY YEAR
SEAL SIGNATURE ~ DATE
'-v-I MAIL~13 , Wappinger Falls, NY 12590 04:1~~ 08 10 2006 10 08 2006
25. B. SOLEMNIZA nON PERIOD
ENDS AT MIDNIGHT ON:
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
o OTHER, SPECIFY
ZIP
1~
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. cou~\L'ft.I~
c.
NAME (PRINT)
SIGNATURE~
nf'l"-l.QA ln~nl'V\R'