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~I AlE UF NEW YURK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FULL NAME ~ony Pald~e
1ST 0 0 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 say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the marriage ate. 11 / .
21. SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~ ~ oti..!..R/J dJ {/?J1. ~
E CUR . U1'f""CUR~E
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ 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 CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~c~ 1368
~5~1~~~R 71
1. A.
CURRENT SURNAME
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B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER n~n.. 7 4-4~~n
2. RESIDENCE A. N~~EY olt B. w~tu~5ter
c. CHECK ONE 0 CITY I!!!r TOWN 0 VILLAGE
AND
SPECIFY RI Jr.h1'ln1'ln
D. STREET ADDRESS 231 Westchester Avenue ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
M03r~ / ~
10511
YES 1!1 NO
/ y~~82
3. A. AGE 23
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Groundman
B. TYPE OF INDUSTRY OR BUSINESS AspllJndh Tree Co
5. PLACE OF BIRTH Y onlffm~ Np.w York
(CITY, STATE I ct:lUNTRY IF NOT USA)
6. FATHER
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A. NAME John William Suite
B. COUNTRY OF BIRTH l J S A
7. MOTHER
A. MAIDEN NAME K1'Ifp.n Ann Morrp.lla
B. COUNTRY OF BIRTH l J S A
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
n n
DEATH
n
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
C. DATE LAST MARRIAGE ENDED?
MONTH OA 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) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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NAME (PRINT)
0=>>1""1" rll....I'I..nwu;n;:.;n
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
.-J
FROM THE BRIDE
11. A. FULL NAME ~~en l\IIari~lIMp'on
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
c. SY~~~JNi~~~~~b~~s~urke
D. SOCIAL SECURITY NUMBER 1?~ 7?-7Q4.n
12. RESIDENCE A. N~~J;'olt B ~S5
C. CHECK ONE 0 CITY [iI' TOWN 0 VILLAGE
AND P hl- .
SPECIFY nlJg 1ItP.P.p~lP.
D. STREET ADDRESS 3 Waters Edge Road ZIP 12601
E. IS RESIOENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES I!l' NO
13. A. AGE 20 3B. DATE OF BIRTH "1 4" ~!:u:~
1':II'ON'rn LlA Y '7EJlR
14. EMPLOYMENT
A. USUAL OCCUPATION Housekeeper
B. TYPE OF INDUSTRY OR BUSINESS c.:olJrtyard Marriott
15. PLACE OF BIRTH Town Of Cortlandt Np.w York
(CITY, STATE / COUNTRY IF NOT UllA)
16. FATHER
A. NAME Gregory Jobn Mason, 5r
B. COUNTRY OF BIRTH l J S A
17. MOTHER
A. MAIDEN NAME Patrir.ia Ann M ~mith
B. COUNTRY OF BIRTH l J S A
1B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
n n
DEATH
n
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
C. DATE LAST MARRIAGE ENDED?
MONTH OA 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) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
TIME
MONTH
YEAR
MONTH
YEAR
nflln7 {?nnfl
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
AM
ZIP 05:44 PM
1~
2B. PLACE WHERE MARRIAGE OCCUR~
A. STATE NEW YORK B. COUNTY~rr;,JIGf
C. LOCATION OF CEREMONY
(CHECK ONE AN~ECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY W HPt ~'l.nI
06
08
2006
08
06 2006
NAME (PRINT)
SIGNATURE~ p