040
0.
N
f-
Z
W
en
W
IX!
C
.....
::l
o
I
en
Z
o
i=
e(
II:
f-
en
a
W
II:
W
o
e(
a:
II:
e(
::2
lL
o
W
f-
e(
()
u::
i=
II:
W'
()
W
II:
W
I
:;:
en
en
W
II:
C
C
e(
>-
lL
5
W
Q.
en
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Jeffrey Georae Maffeo. JR.
MIDDLE CURRENT SURNAME
COaNTY DutchAlt.c;,
CITYfTOWN Wappinger
~~J~~c: 1 AAA
~5~~J~R 40
1. A. FULL NAME
FIRST
I
STATE ALE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 122- ~D3272
D. SOCIAL SECURITY NUMBER --~
2. RESIDENCE A. t\IV B. Dutchess
(MATE) (COUNTY)
C. CHECK ONE 0 CITY ~OWN 0 VILLAGE
AND Wi .
SPECIFY appnger
O. STREET ADDRESS 11 E AlDlne Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIllAGE? 0 YES D~NO
08 / 18 / 197
MONTH DAY YEAR
3. A. AGE 28
3B. DATE OF BIRTH
L 0 SUPPLEMENTAL FILE
~
4. EMPLOYMENT
A. USUAL OCCUPATION Welder
B. TYPE OF INDUSTRY OR BUSINESS Metro- North R R
5. PLACE OF BIRTH Bronx. New Yark
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Jeffr~ George Marfeo. Sr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME
t"..ethMne Judth Scholtz
USA
1
B. COUNTRY OF BIRTH
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATb
FROM IHE BRIBE A'+""I
uyanna ee ,.,. loG e
FIRST MIDD~le CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF ~rlreo
C SURNAME AFTER MARRIAGE &50
. (OPTIONAL. SEE REVERSE) 1~~-62-4v
D. SOCIAL SECU~VUMBER Dutch~
12. RESIDENCE A. (STATE) ., B. (COUNTY)
C. ~~BCK ONEWapp~UeP TOWN 0 VILLAGE
SPECIFY , 'E Ai 'lIe Drive
D. STREET ADDRESS pi
11. A. FULL NAME
12590
.ZIP
.;
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
O. 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
E. IS RESIDENg' WITHIN LIMITS OF CITY OR INCORPORATED VfJS'E? ~ YES:\919
13. A. AGE 2 13.B. DATE OF BIRTH / /
MONTH DAY YEAR
14. EMPLOYMENT
Safety Specialist
A. USUAL OCCUPATION Entergy Ntlclear
B. TYPE OF INDUST~ Q.lLl2lJSItIIF.:l~_" Il
Dronx, ....~ 1 gl
15. PLACE OF BIRTH ·
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER Alfonse Artale
A. NAME USA
B. COUNTRY OF BIRTH
Frances Margaret Gallina
A. MAIDEN NAME U t) A
B. COUNTRY OF BIRTH 1
18. NUMBER OF THIS MARRIAGE
17. MOTHER
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVOllE CIVIL ANNU'()1ENT
DEAT'O
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) o 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
W
III
::;
:::>
z
c
z
<
0--
W
W
II:
lii
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true
as to my right to enter intD the marriage state. _X::J.
21. SIGNATURE OF GROOM ~ -
22. SIGNATUflE OF BRIDE ~
~ ~ ~'~A
DATE
by New York Domestic
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 y 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 forthe purpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK . 25. A. SOLEMNIZATION PERIOD BEGINS
Glona J. Morse
w
en
z
w
(,)
::i
~
{ SEAL }
'-v-I
NAME (PRINT)
TIME
MONTH
SIGNATUR
MAILING ADIC1i~
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED. .
DATE'
"nger Falls, NY 12590
ITYrroWN AlE ZIP
26. SOLEMNIZATION OCCURRED 27. TYPE OF.CEREMONY
TIME MO. DAY YEAR 0 0 RELIGIOUS
9 0 OTHER, SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNT~"'~<UJ
03:~~
1_ CIVIL
~~5
f-~f-
~~~
f-Wz
en.....::2
::lUW
::205
f-zen
z-
5~~
tl:ooo
00-->-
w~C5
t-mlO
~~~
w '-:30 0<0 \ CS
5 "'..\',f~~=~_' JAMESD~.P. GONES TITLS\JtTo~~~!Covr\;J\I~
i:L SIGNATURE ~ . _~tN'x1, ~..' DATE JUl\Cl.. \"1-} 2.005
i= r;L1NG ADDRESS ~
ffi s~~i~~~' '0 C~O~'v..~ ~'-; O"~~f\'-7 N\{ \2.~1
(,) 30. WITNESS TO CE 31. WITNESS TO C~MONY .. ". L
NAME (PRINT) _ ~~ti ~U"Dc......
SIGNATURE~ i ~ ~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF IIil TOWN OF 0 VILLAGE OF
SPECIFY r; ..s.~~'\\ \