088
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Peter Angelo Puglisi
Dutchess
COUNTY '^"~
CITYrrO~ nger
DISTRICT 36&
NUMBER
REGISTER 88
NUMBER
L 0 SUPPLEMENTAL FILE
Christi. FROM THE.BRIDE
na Mane DIllion
11. A. FULL NAME
CURRENT SURNAME
1. A. FULL NAME
MIDDLE
FIRST
CURRENT SURNAME
MIDDUE
FIRST
~
B. BIRTH NAME (MAIDEN NAME), ~T
C. SURNAME AFTER MARRIAGE ~
(OPTIONAL - SEE REVERSE)06S-76-"uu...
D. SOCIAL SE~'. 0utclteBs
12. RESIDENCE A. (STATE)"; B. (COUNTY)
C. gJfiCK OVVapPnji 0 TOWN 0 VILLAGE
SPECIFY 25 ScoIl DI1ve
D. STREET ADDRESS ZIP
E. IS REZCE WITHIN LIMITS OF CITY OR INCORPORAT,tiILLAGE~ 0
13. A. AGE 13.B. DATE OF BIRTH -
MONTH DAY
14. EMPLOYMENT Buyer
A. USUAL OCCUPATION The Wne EnthtlSllSt
B. TYPE OF IND~
15. PLACE OF BIRTH
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER Richard C. Dillion
A. NAME USA
B. COUNTRY OF BIRTH
"-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE),~-3243
D. SOCIAL SECl.!filIY !'l!J~~ER
2. RESIDENCE A. NeW T 0I'k B. DutCheSS
(STATE) r.ITV ~ (COUNTY)
C. X~fiCK ONWa~riSj8r- TOWN 0 VILLAGE
SPECIFY 25 6catl Driv~
D. STREET ADDRESS ZIP
E. IS RE~CE WITHIN LIMITS OF CITY OR INCORPORATEDCirGE? ~
3. A. AGE 3B. DATE OF BIRTH /
MONTH DAY
4. EMPLOYMENT
A. USUAL OCCUPATION R8111 ~~
B. TYPE OF INDUilBY.QR BI,ISt:lf~.... . k
~ NeW Tor
5. PLACE OF BIRTH ·
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER Anthony ~isi
A. NAME USA
B. COUNTRY OF BIRTH
12598
.,
Yf118 NO
YEAR
12510
,,;
Y~8915
YEAR
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17. MOTHER Toni Ann RuggIere
A. MAIDEN NAME U 6. A
B. COUNTRY OF BIRTH 1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DI'(fRCE CIVIL A1fLMENT
7. MOTHER AntonI MuscoIl
A. MAIDEN NAME nI no
B. COUNTRY OF BIRTH ~
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV'15CE . ..' CIVIL ANtfLMENT
DE(fH
DE(fH
(2) 0 DEATH
(3) 0 ANNULMENT
/ /
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(2) 0 DEATH
.(3) 0 ANNULMENT
/ /
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
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
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
o 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
e and belief that the information I provided is true and that I declare that no legal impediment exists
, 22. SIG ATURE OF BRIDE ~ C, ~ p JL.e --
U~CURRENTNAME tMSI1j7~
DATE
by New York Domestic
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CITYrrOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
'2.~A
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY g)r~V1 t{.e
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~N OF 0 VILLAGE OF
SPECIFY Z In hi ;#1 j a rl II e.,
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29. OFFICIANT
NAME (PRINT)
,
NAME (PRINT)
SIGNATURE ~