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DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Scott Patrick wtchey
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
8. HOW DID LAST MARRIAGE END? (3)tJ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 07 /17 /1998
MON]; DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 1] YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
.J!:4,ONTJi DAY, YEAR.!.. _ (?~ STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 0 1STu/11,11998 ~kMpsI.. N y ~ 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
wledge and belief that the information I provid d is Itlgal impediment exists
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COUNTY Dutchess
CITY/TOW~ \Nipplnger
DISTRICT 1~
NUMBER
REGISTER 68
NUMBER
1. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
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B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE064-56-3998
D SOCIAL SE~I~NUMBER
2. RESIDENCE A. B. Dutchess
(STATE) Ii (COUNTY)
C. CHECK 01lva 0 CITY 0 TOWN 0 VILLAGE
~~CIFY ppmger
D STREET ADDRESS Z7 A Scarborough Lane ZIP 1~
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3 A AGE31 38. DATE OF BIRTH D6 /26 /1974
MONTH DAY YEAR
4. EMPLOYMENT
A. L1SUAL OCCUPATION Central ~r
5. :~::~~:I:~~OUgF.~~ s: Met8I Union
(CITY. STATE/COUNTRY IF NOT USA)
FROM THE BRIDE
11. A. FULL NAME Danielle Marie CiDriano
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Di Benedetto
C. SURNAME AFTER MARRIAGE \NItchev
(OPTIONAL. SEE REVERSElfto" ~D_D626
D. SOCIAL SECURITY NUMBER 'UDU"~
12. RESIDENCE A,N Y B. Dutchess
(STATE) ~ (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY~
D. STREET ADDRES71 A ~rborough Lane
ZIP 12590
o YES~ NO
1Q'7A
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE30 13.8. DATE OF BIRTH 09 29
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Insurance & Billina
8. TYPE OF INDUSTRY OR BUSINESS RIverside Women's Health
15. PLACE OF BIRTHBronxvllle. Naw York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAMEGeorge Di Benedetto
B. COUNTRY OF BIRTtU S A
DAY
17. MOTHER
A. MAIDEN NAME Maryann Walker
B. COUNTRY OF BIRTtU S A
1 B. NUMBER OF THIS MARRIAGE 2
DEATH
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23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State f 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 <JaffnE.!l..... .0;..... .. 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) - ~_ "
~ 12ii~;: ~;';;;aIIs. NY~
STREET CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27~TYPE F 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 I '?> ~
PLACE INDICATED. \p 9 0 OTHER, SPECIFY
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6. FATHER
A. NAME Thomas John Wttchey
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Pstrlcle K8therlne Mullarkey
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVerCE CIVIL A'6ULMENT
DSTH
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. co:b.4~W
C. LOCATION OF CEREMONY
(CHECK ONE ~'/". SP CIFY)
rJ CITY OF fi~ F
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B. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
YEAR
MONTH DAY
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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21. SIGNATURE OF GROOM
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30 WITNESS TO~C. EMONY -~!J r
NAME (PRINT) ,L V cI ,~:Bf
SIGNATURE~ "'<JI5 ~
DOH-98 (llI9B)