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COUNTY Dutchess
CITYITOWN Wappinger
1368
38
::s I A II: Ut" NI:VV YUHI\.
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
steven James Falco, Sr.
FROM ~~rit~~~o'l<ortright
(THIS SPACE FOR STATE USE ONL Y)
DISTRICT
NUMBER
REGISTER
NUMBER
L 0 SUPPLEMENTAL FILE
.J
1. A. FULL NAME
11. A. FULL NAME
FIRST MIDD1(.Ortri ht CURRENT SURNI\ME
B. BIRTH NAME (MAIDEN NAME), IF D~~f~ g
C. SURNAME AFTER MARRIAGE
(OPTIONAL' S[:E REVERSE) wfl.48-2548
D. SOCIAL SECU~ ~MBER Dutchess
12. RESIDENCE A. (STATE) .; B. (COUNTY)
C. ~~6CK ONE Wa~C.rgers T~If1 VILLAGE
SPECIFY 37 N. GilrmJI c Blvd.
D. STREET ADDRESS
FIRST
MIDDLE
CURRENT SURNAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) Q-r7 r::.c .0618
D. SOCIAL SECURITY NUMBER " ,.~
2 RESIDENCE A. N Y B. Dutchess
(STATE) .; (COUNTY)
C CHECK ONE 0 CITY 0 TOWN .D "'VILLAGE
D. :~:~: ADDR:P~,nr~I:~~e BlVd. ZIP 12590
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 ~ES 0 NO'
06/ 21 / 195
12590
ZIP ."
29 Y/~~
YEAR
DAY
YEAR
E. IS RESIDEfs WITHIN LIMITS OF CITY OR INCORPORATED VIWE?
13. A. AGE 13.B. DATE OF BIRTH /
MONTH
14. EMPLOYMENT
3. A. AGE
45
MONTH
Homemaker
DAY
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Ironworker
B. TYPE OF INDUSTRY OR BUSINESS L.oc8I 40
5. PLACE OF BIRTH \Mllte Plains, New York
(CITY. STATE/COUNTRY IF NOT USA)
A. USUAL OCCUPATION
B. TYPE OF INDUST~Q.'iJ3..l-'SIN~l;l N . . k
15. PLACE OF BIRTH UyugnsDUrg, f/!JW 1 01
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Bobby Herbert Kortright
USA
B. COUNTRY OF BIRTH
17. MOTHER
6. FATHER
James Falco
8. COUNTRY OF BIRTH Italy
7. MOTHER
A. NAME
Eileen Frances DeYJItt
A. MAIDEN NAME USA
B. COUNTRY OF BIRTH 3
18. NUMBER OF THIS MARRIAGE
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Marianne BailY
USA
1
8. NUMBER OF THIS MARRIAGE
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19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO~E CIVIL ANNU1t)'ENT
.,.
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH 8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (23) 0 A~ENT ~99tJATH
C. DATE LAST MARRIAGE ENDED? / / C. DATE LAST MARRIAGE ENDED? _...'Y' /
MONTH DAY YEAR MONTH '"' DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MO~4!m9 f)otig'll~Jile: 'NTf'A) SELF SPOUSE.;
o 1 ST ud2811990 Poughkeep5le, N y 0 0.;
o ;!ND 0 0
o 3RD 0 0
o ~H 0 0
· t~t t ,;"ro~.ti'" t p'~;~. t~ t, j ;j:B1;lf~
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNU~ENT
o U .
DEATb
DEATf-Q
21. SIGNATURE OF GROOM ~
by N~w York Domestic
1ST
2ND
3RD
4TH
I, being duly swom, depose and say,
as 10 my right to enter into the .
DATE
w
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(,)
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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 of 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 CITY CLERK. 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) Glona J. Morse
05124(2 TIME MONTH
SEAL SIGNATURE ~ D TE
'-v-I MAILlN2tfl1(fde ,NY 12590
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29. OFFICIANT 0
NAME (PRINT)
02:$~
ZIP
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYJJVlCff.el;.
~
CIVIL
LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ;lKVILLAGE OF
SPECIFYtlkm .~ps ~
C.
m"rltIm92 ~~4I271
SIGNATURE ~ '/~ DATE IIJttI' bl' 2C)OS
MAILlrr~{5SGRvOrR, i1iPfN~ ff;-J.I.S 'A'f ~S~
STREET CITYITOWN STATE
30. WITNESS TO CE~MONY E>--rY.?~,.r-
.L/~AI/J/ ~ -:;) 1'~'7 I l<:>
NAME (PRINT)
31.
NAME (PRINT)
SIGNATURE