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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Robert Ragone
COUNTY Dutchess
CITYITOWjJ wa~nger
DISTRICT 1368
NUMBER
REGISTER 134
NUMBER
1. A. FULL NAME
MIDDLE
CURRENT SURNAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT'
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 1 1 &- (4-:>>011
D. SOCIAL SEC~'ER
2. RESIDENCE A. ark B. DutchesS
(STATE) r.ITY ~ (COUNTY)
C. ~~5CK ON'VvaPii&- TOWN 0 VILLAGE
SPECIFY 7 l<erlddl DrIve
D. STREET ADDRESS ZIP
E. IS RES~CE WITHIN LIMITS OF CITY OR INCORPORATED il,GE? 1 ~
3. A. AGE 3B. DATE OF BIRTH /
MONTH DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Route Salesman
B. TYPE OF INDU~RY MI1fiw~:: SptIng
5. PLACE OF BIRTH on ,
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER .
A. NAME Richard Ragone, Sr.
8. COUNTRY OF BIRTH U 6 A
7. MOTHER R Ti'-'"
A. MAIDEN NAME osemery ~
8. COUNTRY OF BIRTH U ~ A
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV~CE CIVIL ANtfLMENT
DEtj"H
12590
.;
Y~89W2
YEAR
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8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE' OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Meghan K. Bums
---l
11. A. FULL NAME
MIDDLE
CURRENT SURNAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IEflJFERENT
C. SURNAME AFTER MARRIAGE rns
(OPTIONAL. SEE REVERSE) 1;l~ 10-/13:)
12. ~~S~::~:~ :E~~&Ic B. Dutchess
(STATE)., (COUNTY)
C. ~~5CK O~1Sh1dii CITY 0 TOWN 0 VILLAGE
SPECIFY 41 HIItDp Crete 12524
D. STREET ADDRESS ZIP .;
E. IS RE~CE WITHIN LIMITS OF CITY OR INCORPORATitiILLAGE? 4J) 0 ~~ NO
13. A, AGE 13.B. DATE OF BIRTH ~ ~
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Unemployed
B. TYPE OF IND.~~ T'bI'k
15. PLACE OF BIRTH
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER .
A. NAME 11lom_ Frances Bums, Jr.
B. COUNTRY OF BIRTHU 6 A
17. MOTHER
A. MAIDEN NAME SIlly Je~ BoscoIe
B. COUNTRY OF BIRTHU 6 1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DI(j'RCE CIVIL A1)ULMENT
D1)TH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITI', STATElCOUNTRY, IF NOT USA) SELF SPOUSE
II:
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1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, that to
as to my right to enter into the marri!!ge s
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
edge and belief that the information I provided is true and
o 0
o 0
o 0
o 0
al impediment exists
21. SIGNATURE OF GROOM ~ .
23. SUBSCRIBED AND SWORN TO BE ORE ME USE CURRENT NAME 10I25l2OO5
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New Y k 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 c'BFrt. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (~RINT) II
SEAL SIGNATURE "" './': :~ DATE 10I25l2OO5 TIME
'-v-I M"20 ~ ppinger Falls, NY 12590 02:05 ~M 10
STREET CITYfTOWN STATE ZIP M
~~~R~~~RT~~~ 10~0~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 00 RELIGIOUS 10 CIVIL
DATE AND AT THE TIME AND ,,"t,J 0"')9 tll"Y\ N. (}Qr-:.s...... l\ '
PLACE INDICATED. LA:T. "'\ "'-<-V' 9 'f" OTHER, SPECIFY r~. ...../lO U.fI
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MONTH
YEAR
MONTH
YEAR
26
2005
12
24 2005
IU/jJ J S7o:.
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28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY eor~'I,.~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF rk. TOWN OF 0 VILLAGE OF
TITLE
DATE
STREET
30. WITNESS TO CEREMONY
NAME (PRINT) /? Ie. It /I"cI 'T.I? A 6t".... ~ 7' y,
SIGNATURE ~ /tt..,A~/ 7' ;- /'.
DOH.98 (11/98)
STD,\.ly
Pt:l.IJT
SPECIFY
ZIP
31. WITNESS :'~MONY
NAME (PRINT) F \ l'i
SIGNATURE ~