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~IAII: Uf NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
AIfr~ Paul Momt9ari
COUNT'Outchess
CITYfTOWNWappinger
~~~~~c;;r3 368
REGISTE 1 0
NUMBER 1
1. A. FULL NAME
CURRENT SURNAME
~ I A I t: tlL~ NUMtst:H
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSEl..
D. SOCIAL SECURITY NUMBER u8a 74 1857
2. RESIDENCE A.N_AXpfk B. O\MiMss
C CHECK ONE 0 CITY -EJ TOWN 0 VILLAGE
AND
SPECIFY W.appinger
o STREET ADDREss26 Fleetwood nrivp- ZIP 1?590
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES"tJ NO
~H /1 [ly /1~1)
3. A. AGE33
4. EMPLOYMENT
3B. DATE OF BIRTH
11. A. FULLNAMELeanfle Marip- Hosking
FIRST MIDDLE
CURRENT SURNAME
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A USUAL OCCUPATION Cor:rections Sergeant
B. TYPE OF INDUSTRY OR BUSINESS GreiF!p Havp-n Prison
5 PLACE OF BIRTHP~I~~~~P ~Eflt) York
6. FATHER
A. NAME Paul Vincent Montegari
B. COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Dolores Mary Garofalo
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
(2) 0 DEATH
B BIRTH NAME (MAIDEN NAMEI, IF DIFFERENT
C. SURNAME AFTER MARRIAGE Montp-gari
(OPTIONAL - SEE REVERSE...
D. SOCIAL SECURITY NUMBER n95-64-0551
12 RESIDENCE PNe'ftTXerk BD~c~~~~s
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
ANDUIf .
SPECIFy.-.applnger
D. STREET ADDRES:26 Fleetwood Drive
ZIP12590
o YES"D NO
1915
DAY YEAR
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E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE3D 13.B. DATE OF BIRTH nft 71
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATIONCorrection Officer
B. TYPE OF INDUSTRY OR BUSINEssGreen Haven prison
15. PLACE OF BIRT~iddletown. New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAMEMichael Joseph Hosking
B. COUNTRY OF BIRTtU S A
17. MOTHER
A. MAIDEN NAMElCathleen .Iane Lynch
B. COUNTRY OF BIRTtU S A
lB. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
B. HOW 010 LAST MARRIAGE END? (3) 0 DIVORCE
(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, STATElCDUNTRY, IF NOT USA) SELF SPOUSE
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) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 0
o 0
o 0
o 0
ediment exists
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1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I, being duly sworn, depDse and say, that to the best of my knowledge and belief that the information I provided is tru
as tD my right tD enter intD the marriage state.
21. SIGNATURE OF GROOM ~ 0
USE CUR ENT NAME
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride 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 CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) J~~n
SEAL SIGNATURE ~ t. C /J'{~~-:;::;" DATE 09/07/2005
MAILING ADORES AM
'-.;-I ?n tJli(tdlp-hllsh Rd Wappinner Falls, NY 12590 07..06 PM 09
ST~~ ' CITmQWN r: STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27~TYPE CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 ELlGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND ...
PLACE INDICATED 2:- 3'0 PM f 0 9 0 OTHER, SPECIFY
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DATE
by New York Domestic
TIME
MONTH
YEAR
MONTH
YEAR
08
2005
11
06 2005
f~ut'
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTJhfr~5'<;'
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY ~<,-t ~ slU{
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SIGNATURE ~
MAILING ADDRESS
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STREET
30. WITNESS TO C
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