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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
John F. Campagna
23. SUBSCRIBED AND SWORN 0
SIGNATURE OF TOWN OR I CLERK ~ DATE
This license authorizes the marriage in New York Stat of the authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within w York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
D If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITYSI~8 J. M . 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) &, . orse TIME MONTH
SEAL ~2~m.~.~/i:f/>>..:f/~'!. t;~lsDNY = AM
'-.-' ~ ppjtlger, 12:23M 04
STREET CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
Dutchess
COUNTY 'vVappillgf;1
g:~~~gWN 1388
~~~I~~~R 22
NUMBER
1 . A. FULL NAME
MIDDLE
CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
FIRST
0-
N
B BIRTH NAME, IF DIFFERENT
C s~~~~~J~~~~~t~~~~~SE) 117.32-9961
D SOCIAL SECURll'4 eli.lJ.OrK
N...... T Dutchess
2. RESIDENCE A. B.
(STATE)" (COUNTY)
C ~~6CK ONE EaSt F'iStliCilloWN D VILlAGE
SPECIFY '1 Pt$Jlti5:J DrivC! 12533
D. STREET ADDRESS
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Antonia M. Walsh
~
ZIP
E. IS RESID~ WITHiN LIMITS OF CITY OR INCORPORATED VI~~E?
3. A. AGE 3B. DATE OF BIRTH /
MONTH
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4. EMPLOYMENT
A. USUAL OCCUPATION
Retired
11. A. FULL NAME
FIRST MIDDLMavilla CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DI(5ERENT
C. SURNAME AFTER MARRIAGEampagna
(OPTlONAL- SEE REVERSE) lUL-4L-,lL;J{
D. SOCIAL SECURJ.T)' NUMm:e utch
New yark D ess
12. RESIDENCE A. B.
(STATE)., (COUNTY)
C. ~~6CK ONE East FiihMI TOWN D VILLAGE
SPECIFY 1 P nti DI-
re 55 rye
D. STREET ADDRESS
ZIP
12533
B. TYPE OF INDUSTMUn'lE1\a1
5. PLACE OF BIRTH .' Y
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER Ant .
A. NAME DnlO Campagna
B. COUNTRY OF BIRTH Italy
7. MOTHER
Rosene Chillemi
lta!y
B COUNTRY OF BIRTH 2
8. NUMBER OF THIS MARRIAGE
A. MAIDEN NAME
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORtf CIVIL ANN~ENT
DEAT~
.;
iJO~EATH
.,
E. IS RESID~ WITHIN LIMITS OF CITY OR INCORPORATED V~E? ~ YES ~ NO
13. A. AGE 13.B. DATE OF BIRTH / 1 / 954
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION
Retired
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE 12(3) D ^a~ENT
C. DATE LAST MARRIAGE ENDED? V /
MONTH r1{fIf
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
YEAR
1ST
2ND
3RD
4TH
I, being duly sworn, depose an
as tD my right to enter intD the
D
D
D
B. TYPE OF INDUST~ OR B~m1-:1 N rk
15. PLACE OF BIRTH oug ...-e, f!/'N YO
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER .
A. NAME Joseph Armando George Mavllla
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Dorothy Dolores Notamlcole
B. COUNTRY OF BIRTH U S P:
18. NUMBER OF THIS MARRIAGE '"
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVObCE CIVIL ANNUbMENT
DEAT1
.,
1~~EATH
21.
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B. HOW DID LAST MARRIAGE END? (3) D DIVORCE09 (3) D A~LMENT
C. DATE LAST MARRIAGE ENDED? V /
MONTH D4J'
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
YEAR
D
D
D
D
D
D
D
D
D
YEAR
i=N" CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~It~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF~WN OF D VILLAGE OF
SPECIFYU]lJ.fP i' f jf" r
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RELIGIOUS
29. OFFICIANT
NAME (PRINT)
-----=
31.
NAME (PRINT)
SIGNATURE ~