086
0.
N
+
w
....
<
....
....
Z
w
(/)
W
lD
o
--'
::>
o
I
(/)
Z
o
i=
<
a:
....
(/)
a
w
a:
w
Cl
<
a:
a:
<
::E
u.
o
w
....
<:
u
u:
i=
a:
w
u
w
a:
w
I
;:
(/)
(/)
w
a:
o
o
<
~
13
w
"-
(/)
+
~~~ W
....;:.... ~
ll!~~ <C
tii~~ (,)
::>uw
::ECl5 i:L
~~(I) -
~~15 ~
fEO(/) W
0....,. (,)
w~<!j
~ffil()
~~~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Shawn Michael Fitzqerald
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
~~J~~c~ 1368
~~~I;~~R 86
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 062-68-8026
D. SOCIAL SECURITY NUMBER
2. RESIDENCEA. New York B. Westchester
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Yorktown
D STREET ADDRESS 2890 Boston Court
ZIP
10598
:; I A I ~ t'1L.~ NUMtl~H
(THIS SPACE FOR STA TE USE ONL Y)
Nor
llsf.j)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Christina Anne Fanitzi
MIDDLE CURRENT SURNAME
~
1 1. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Fanitzi
(OPTIONAL' SEE REVERSE) 053-78-6150
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Ulster
(STATE) d (COUNTY)
C. CHECK ONE 0 CITY TOWN 0 VILLAGE
AND M'lt
SPECIFY I on
D STREET ADDRESS 17 Kldgecrest Unve
3. A. AGE 24
E. IS RESIDENCE WITHIN LIMITS OF CllY OR INCORPORATED VilLAGE? 0 YES r1 NO E. IS RESIDENCE WITHIN LIMITS OF CllY OR INCORPORATED VILLAGE? 0 YES 0' NO
12 / 05 / 1981 13. A. AGE 24 3B. DATE OF BIRTH 08 /20 /1981
MONTH DAY YEAR MONTH DAY YEAR
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFOR
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York Stale of the ride 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 CITYJO-~'fl C, Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Military
B. TYPE OF INDUSTRY OR BUSINESS U, S, Army
5. PLACE OF BIRTH Manhattan, New York
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Patrick Fitzserald
B. COUNTRY OF BIRTH U A
7. MOTHER
A. MAIDEN NAME Carolyn Cate
USA
B. COUNTRY OF BIRTH
1
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO~CE CIVil ANN~LMENT
DEAcr
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
'0. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
a:"
w
lD
::;
::>
z
o
z
<
....
w
w
a:
>-
(/)
1ST
2ND
3RD
o
o
o
21. SIGNATURE OF GROOM~ '
W
en
z
W
(,)
::i
~
{ SEAL }
"-.t-I
SIGNATURE ~
MAIL!'e "Ml~
DATE
appinger Falls, NY 12590
2B. PLACE WHERE MARRIAGE OCCURRED
14. EMPLOYMENT
A. USUAL OCCUPATION Military
B. TYPE OF INDUSJflY OJ? BUSIN,ESS U, S. Army
15. PLACE OF BIRTH NewDurgn, New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Anthony Fanitzi
, USA
B. COUNTRY OF BIRTH
17. MOTHER ' , h
A. MAIDEN NAME Kathleen Patncla Nas
USA
B. COUNTRY OF BIRTH I
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV8RCE CIVIL AN~LMENT
D~H
B. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. ~ YEAR
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, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
o
o
o
DATE
by New York Domestic
TIME
MONTH
YEAR
MONTH
YEAR
ZIP
02:3~~
07
2006
09
CITYITOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
AM
PM
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
A. STATE NEW YORK B. COUNTY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF 0 VILLAGE OF
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29. OFFICIANT
NAME (PRINT)
TITLE
SIGNATURE ~
MAILING ADDRESS
DATE
STREET
30. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~
DOH.98 (03/2006)
CITYfTOWN
SPECIFY
STATE
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE"