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~IATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
William John Halvey
Dutchess
COUNTY
wappInger
CITyrrO\lllJj..
DISTRICT'I ,jtii:l
NUMBER
REGISTER 1 Uti
NUMBER
1. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE094-64-0633
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B Dutchess
(STATE) v (COUNTY)
C. CHECK O~F",. 0 CITY O,..rOWN 0 VilLAGE
~~~CIFY vvapplngers r-alls
6'1 East Main street '12590
D. STREET ADDRESS Z~
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES.Q" NO
3 A. AGE24 38. DATE OF BIRTH 10 /28 ~80
MONTH DAY YEAR
4. EMPLOYMENT ,
A. USUAL OCCUPATION Funeral DIrector
Straub Funeral Home
8. TYPE OF IND~TRY OR BUs.INE;SS ..to
ceacon New Y 011\
5. PLACE OF BIRTH '
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME Peter T, Halvey
, USA
8. COUNTRY OF BIRTH
7. MOTHER K th' D'
A. MAIDEN NAME a Ie lener
USA
8. COUNTRY OF BIRTH I
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVifCE CIVil A~UlMENT
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B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? / /
(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
~IAI~ ~IL~ NUMtl~H
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
~
FROM THE BRIDE
11. A. FULL NAME Kristin Leigh Catalano
FIRST MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), !f..DIFfEfjENT
C. SURNAME AFTER MARRIAGE c:alalano
(OPTIONAL - SEE REVERSE093-66-0215
D. SOCIAL SECURITY NUMBER
12 RESIDENCE ANew York B Dutchess
(STATE) oJ' (COUNTY)
C. CHECK Q.t1f. 0 CITY 0. TQWN 0 VilLAGE
~~~CIFY vvapplngers r- ails
6 I East Main street 12590
D. STREET ADDRESS ~
E. IS RE2DENCE WITHIN LIMITS OF CITY OR INCORPORATE6 VILLAGE? 0 YIjl!"Q. NO
13. A. AGE 3 13.B. DATE OF BIRTH 0 ~ 1~
MONTH DAY YEAR
14. EMPLOYMENT ,
A. USUAL OCCUPATION Funeral DIrector
straub Funeral Home
8. TYPE OF IND'frRY oN~W"'ork
15. PLACE OF BIRTH oy,
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A NAMESamuel F, Catalano, Jr,
. USA
B. COUNTRY OF BIRTH
17. MOTHER Sh H I
aron a e
A. MAIDEN NAME
USA
8. COUNTRY OF BIRTH 1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVil A'ttUlMENT
DitTH
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
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
no lega impediment exists
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1 ST 0 0 1 ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is tru
as to my right to enter into t~e ma~riage state., .
21.
E 09107/2005
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 911 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 C30 LEt::, Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
23.
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{ SEAL}
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SIGNATURE ~
M2ftl
09/07/2005
DATE
appinger Falls, NY 12590
01:01 ~~ 09
ZIP
08
2005
11
06 2005
CITYITOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
3>
TIME
MONTH
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON'
YEAR
MONTH
DAY
YEAR
10 CIVil
28. PLACE WHERE MARRIAGE ocfrl.EBANy
A. STATE NEW YORK B. COUNTY
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
~ OF 0 TOWN OF 0 VILLAGE OF
SPECIFY Wft/Grtvw c:T rV y
s.r: 13 fl.. \ G I 0 '.5 c:...tt-U 1~c.A..l.-
31.
NAME (PRINT)
SIGNATURE ~