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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Mark: Christopher Schmitt
FIRST MIDDLE CURRENT SURNAME
~t' J 22. SIGNATUR~OF BRIDE"
/-.I-~ ~~
This license authorizes the marriage in New York State of e 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) Joh C Masterson
SEAL SIGNATURE ~ DATE 08131/2005 TIME MONTH YEAR
MA~if~cfc1fi sh Rd, Wappinger Falls, NY 12590 05:34~~ 09 01 2005
~ STREET crrvrrOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0}i1 RELIGIOUS
~~~E ~~gllT~~E TIME AND 1/: 30 ~ I () _ / _ d 5" 9 0 OTHER, SPECIFY
~~~l~~~~~ <f.e-v:]#)RNAM S I<Etr(
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CITY fTOWN
couNrI1utchess
CITYfTowJNappinger
~~J~~CR" 368
~5~I~J~P.t 02
1. A. FULL NAME
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B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE1047 56-4783
D. SOCIAL SECURITY NUMBER ". -
2. RESIDENCEA.New York: B. Ulster
(STATE) (COUNTY)
C. CHECK ONE 0 CITY -tJ TOWN 0 VILLAGE
~~~CIFY Marbletown
D. STREET ADDREss499 Cherry Hill Road ZIP 12240
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIUAGE? 0 YES"'O NO
3. A. AGE45 3B. DATE OF BIRTH 01 /09 /1960
MONTH OAY YEAR
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4. EMPLOYMENT
A. USUAL OCCUPATION Self-emDloved
B. TYPE OF INDUSTRY OR BUSINESS Restaurant
5. PLACE OF BIRTH~~T~T~~OU~~N!~~
6. FATHER
A. NAME Geor:ge Joseph Schmitt
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Christine Anne Schneider
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
o 0
DEATH
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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
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
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1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, that to the best of my kn
as to my right to enter into the marri
21. SIGNATURE OF GROOM ~
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TITLE
SIGNATURE ~
MAILING ADDRESS
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/98)
I
STATE FILE NUMBER
{THIS SPACE FOR STATE USEONLYJ
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11. A.
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE C
FULL NAME Deborah Michelle Calimano
FIRST MIDDLE
~
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Schmitt
(OPTIONAL - SEE REVERSE088-68-7217
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANew York B.Ulster
(STATE) vi (COUNTY)
C. CHECK~ I [J CITY 0 TOWN 0 VILLAGE
AND arb mown
SPECI 'lI"99 en Hili R d 12240
D. STREET ADDRESS" erry oa ZIP
~
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORAH~ VILLAGEn~ 0 1~-M NO
13. A. AGE32 13.B. DATE OF BIRTH ~ ~
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATIONcontracl Manager .
Care Core Nabon~1
B. TYPE OF IND~TRY OFtiUSINESS N "t tit:
15. PLACE OF BIRTH oug eepsle, ew 0
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Michael Christopher Calimano
B. COUNTRY OF BIRTHU ~ A
17. MOTHER .. A W I h
A. MAIDEN NAME CeCIlia nn a s
B. COUNTRY OF BIRTHU S ~
1 B. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DlffRCE CIVIL A'fjULMENT
DEQTH
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) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
at the information I provided is
...
MONTH
YEAR
10
10 CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY t/l>re r
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ){ VILLAGE OF
SPECIFY --A4 oP ?a. )f-z....
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