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DutcheSS
COUNTY ~~n
ClTYfTO~ 368 ger
DISTRICT
NUMBER 28
REGISTER
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseph S. Dirubbo, JR.
I
STATE ALE NUMBER
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
.-l
FROM THE BRIDE
Annelise P. Giovinazzo
1. A. FUll NAME
11. A. FUll NAME
FIRST MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF OFfERENT Trznadel
c. SURNAME AFTER MARRIAGE lrubbo
(OPTIONAL - SEE REVERSE) 109-64-1089
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE) ,; (COUNTY)
C. CHECK ON~ . L O. CITY 0 JD""~ 0 VILLAGE
~~CIFY vvapplngers l-all8
D. STREET ADDRESS 1 ~8 Route 9 APl1 B ZIP 1~
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIUAGE? r1 YES 0 NO
13. A. AGE 40 13.B. DATE OF BIRTH 03 /12 )1965
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Toll Collector
B. TYPE OF INDUSJ~Y O~_~USINF..Sp N Y S Tnruway Autn.
15. PLACE OF BIRTH lonKers, NfN/ YOrk
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME \Mncenty Trznadel
B. COUNTRY OF BIRTH POIana
CURRENT SURNAME
RRST
MIDDLE
CURRENT SURNAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAl - SEE REVERSE) 00tS-4U-~ f13
D. SOCIAL SECUL\IIY NUMI!IiR
2. RESIDENCE A. New' york B. Dutchess
(STATE) '" (COUNTY)
C. CHECK ONEW 0 .CITY 0 ~;U 0 VILLAGE
t~CIFY applngers a 8
D. STREET ADDRESS '1548 Route 9 Apt. 1 B
ZIP 12590
"
3. ~.. ~:~WITHW :SD:~:FO:I:RPORATED V06E/ ~ -Y~P1973
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Toll CoIlecter
B. TYPE OF INDUSay OR.!lIlSIN~~ N l S Thurway Auth.
5. PLACE OF BIRTH amaen. NfN/ Jersey
(CITY, STATEtCOUNTRY IF NOT USA)
6. FATHER
A NAME Joseph S. Dirubbo
B: COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Helen E. Laitinen
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
17. MOTHER
A. MAIDEN NAME Hlldegard ZoInhofer
B. COUNTRY OF BIRTH Germany
18. NUMBER OF THIS MARRIAGE 2
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19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV,RCE CIVIL ANN~LMENT
'"
B. HC7N DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT _.l?l..r:;J. DEATH
C. DATE LAST MARRIAGE ENDED? / / C. DATE LAST MARRIAGE ENDED? 12 / 19 / Z!JW
MONTH DAY YEAR MONTH .; DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? O'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 (MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELIF SPOUSE
o 1ST 12/1912000 New CItY. New York 0'" 0
o ~D 0 0
o 3RD 0 0
o 4TH 0 0
belief that the information I provided is true and t t I declare that no legal impediment exists
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVOffE CIVIL AN'tiLMENT
DEAbH
DEATH
o
1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, t
as to my right to enter into the m .
21. SIGNATURE OF GROOM .
22. SIGNATURE OF BRIDE
DATE
by New York Domestic
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23. SUBSCRIBED AND SWORN T
SIGNATURE OF TOWN OR C CLERK.
This license authorizes the marriage in New York St e of the bride and groom named above by any person authorized
Relations Law ~11 to perfonn marriage ceremonies withi 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 CIlJ:"vLEI3K 25. A. SOLEMNIZATION PERIOD BEGINS
{ SEAL } :::.-: ~~1~: ~~;'J~ o^', 04Q5/2\llI5 "ME MO","
'-...-' ~~ R ppi Falls, NY 12590 03:02~~ 04
STREET CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27~TY. E OF CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 RELIGIOUS 10 CIVIL
DATE AND AT THE TIME AND A f "..,
PLACE INDICATED. 03 ~1o M t, (1 () \ 9 0 OTHER. SPECIFY
1i~'::l\ ~!/j4tj- ()d.P~ ""-, VDI r [lMJJJ
SIGNATURE ~ ~I::-~ _ DATE ,)tW0 If, j;DD 5
MAILING ADDRESS -
fl. o. B 0 V d.-/ I (iJO/JE.Alfi tit 12~'t 'if
STREET CITYfTOWN . STATE ZIP
30. WITNESS T9\CEREMONY 31. WITNESS TO CEREMONY
NAME (PRINT) \ \ \ NAME (PRINT)
YEAR
28. PLACE WHERE. MARRIAGE OCCURRED
A. STAT~ NEW YORK B. COUNTY ~~tb~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
.Ji CITY OF 0 TOWN OF 0 VILLAGE OF
PIJILGf/ K&lf5/t
SPECIFY
SIGNATURE.
DOH-98 (11198)
SIGNATURE.