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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
Mi~~n:.i~
Dutchess
COUNTY \MIpp
CITYrro~ nger
DISTRICT 368
NUMBER 133
REGISTER
NUMBER
1.. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
a.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE .
(OPTIONAL - SEE REVERSE)031-:S8-6887
D SOCIAL SE~Uf&k
2. RESIOENCE A. B. DUtCne&S
(STATE)'" (COUNlY)
C. ~6CK ONWapJjrijiirD TOWN 0 VILLAGE
SPECIFY 38 A eswtbu.uugh lanG
O. STREET ADDRESS ZIP
E. IS RE~CE WITHIN UMITS OF CITY OR INCORPORATED~GE?j1' 20
3. A. AGE 3B. DATE OF BIRTH -
MONTH DAY
4. EMPLOYMENT .
A. USUAL OCCUPATION ArboristT ~...
reD ga "Ice
B. TYPE OF IND~aS\4 ach~
5. PLACE OF BIRTH ' 'ill
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER Robert Secctia
A. NAME USA
B. COUNTRY OF BIRTH
7. MOTHER R I'Io.Ab.
A. MAIDEN NAME oseenn ""WllClno
B. COUNTRY OF BIRTH U 5, A
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DlV~CE ~IVIL AttiULMENT
D1)TH
1~
.;
Y~913
YEAR
B. HOW DID LAST MARRIAGE END? (3~{3t D.IVORCE'
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
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
I
(THIS SPACE FOR STATE USE ONLY)
11. A.
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
FULL NAME Kerry Lynn PlzzJJro
FIRST MIDDLE
B. BIRTH NAME (MAIDEN NAME), ~
C. SURNAME AFTER MARRIAGE a
(OPTIONAL - SEE REVERSE)1~::KJ-4{t);:I
o SOCIALSE='~
12. RESIDENCE A. B. DutCheSS
(ST ATE)'" (COUNlY)
C. ~6CK ""-~ 0 TOWN 0 VILLAGE
SPECIFY 36 A 6car~ Lane
D. STREET ADDRESS
E. IS RE!2NCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 13.B. DATE OF BIRTH 11
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Banker
B. TYPE OF IND~ J'('~ESS c:: Ba::nc
15. PLACE OF BIRTH ra, fIN
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER R Louis A'Zza
A NAME oger ro
B: COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Cenci SUe V\IhItney
B. COUNTRY OF BIRTHU 5 ~ '.' .'
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DifRCE CIVIL A~ULMENT
CURRENT SURNAME
ZIP 12590
o
NO
DtiTH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
,C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. A~E 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) (CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
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1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, that to t
as to my right to enter into the marriage sta
21. SIGNATURE OF GROOM ~
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
owledge and belief that the information I provide
23. SUBSCRIBED AND SWORN TO BEFORE ME E 1011212005
SIGNATURE OF TOWN OR CITY C~ERK ~ DATE
This license authorizes the marriage in of the bride and groom named above by any erson authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within W York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~. M 25. A. SOLEMNIZATION PERIOD BEGINS
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{ SEAL }
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TIME
MONTH
AM 10
:54 PM
13
2005
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE 'PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATE~
STATE
2~. TY~'OF CEREMONY..
o ~ELlGlOUS
9 0 OTHER. SPECIFY
10 CIVIL
o 0
o 0
o 0
o 0
t no legal impediment exists
YEAR
MONTH
YEAR
12
11 2005
28. PLACE WHERE MARRIAGE f!2'f~. :Y
A. STATE NEW YORK j/~'7
C. LOCATION OF CEREMONY
(CHECK ONE AN~ECIFY)
o CITY OF p(TOWN OF 0 VILLAGE OF
SPECIFY /~( 7
_,. II
TITLE \ '- j) f! J~.!) /
DATE / t' I"" Ii Iv )'
I i,/.,.
I yJ y
29. OFFICIANT,
NAME (PRINT)
s~
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:t. NtO~ r/ ~I fA...
STATE
SIGNATURE
-