014
"-
N
I-
Z
W
C/)
W
OJ
g
::>
o
I
C/)
Z
o
;:::
<(
a:
I-
C/)
C3
w
a:
w_
CJ(I)
,~
OJ:
w_
1-.-
i:iE
~U)
a:
w
O-r-
wit)
a:
w
I
:;:
C/)
C/)
w
a:
Cl
Cl
<(
>-
u.
<3
w
D-
Ol
~:I::i
::>toQ W
~:;:!;( t-
a:~N .A'
t;)~~ ......
::>Ow ()
:2 CJ <5 u::
~~U) _
~~~ I-
[EOC/) a:
01->- W
W~C5 ()
b~U1
Z::i~
COUNTY Dutchess
CITYfTOWN WaDOinger
~~~~kc; 1368
~5~I~J~R 14
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
stP.Alen M RAlIAl'1toni
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~mMary Bi~T SURNAME
~
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT "'Allis
C. SURNAME AFTER MARRIAGE Disnoo """-11-.....-".'
(OPTIONAL _ SEE REVERSEr-' PIW'I IlIrRV
D. SOCIAL SECURITY NUMBER 058 64 2937
12 RESIDENCE A N"~Qrk B ~
C. ~~6CK ONE 0 CITY ~OWN 0 VILLAGE
SPECIFY \Nappinger
D. STREET ADDRESS 5t. Smith Crossing Road ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
13. A. AGE 40 13.B. DATE OF BIRTH MQ7H / Wy ~
14. EMPLOYMENT
A. USUAL OCCUPATION Homemaker
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH ~()U~~~
16. FATHER
B BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 1 '3-.~'-n4AA
2. RESIDENCE A. New Yark' B. n. rtclless
(STATE) ~
C. CHECK ONE 0 CITY lJ" TOWN 0 VILLAGE
AND W .
SPECIFY appnger
D STREET ADDRESS 51 Smith Crossing Road ZIP
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
3. A. AGE 4~ 38. DATE OF BIRTH MO~ / ~
1?~90
YES rY NO
/.1
4. EMPLOYMENT
A. USUAL OCCUPATION Pharmacim
8. TYPE OF INDUSTRY OR BUSINESS Rite Aid Pharmacy
5. PLACE OF BIRTH ~~~!lrU~~N~ ca't'
6. FATHER
A. NAME Pasquale Thomas RelIs:mtnni
B. COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Sally Ann Dalley
8. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
A. NAME Albert George '..^Allis
8. COUNTRY OF BIRTH U S .1\
17. MOTHER
A. MAIDEN NAME Vir-glnie Jean Caroli
B. COUNTRY OF BIRTH US.^.
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
(2) 0 DEATH
1 0 0
B. HOW DID LAST MARRIAGE END? (3) [jI'oIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 49 / ~ / ~
MONTH. !fill'" ~
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 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
8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
MONTH DAY YEAR
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
a:
w
OJ
::;;
::>
z
o
z
<(
I-
W
W
a:
....
00
o 0 1ST 1008J2002 Poughkeepsie, N Y 0 ~
o 0 2ND 0 0
o 0 ~D 0 0
o 0 4TH 0 0
knowledge and behef that the information I provided IS tr~e and t I declare that no legal.lmpediment exists
J 22 SIGNATURE OF BRIDE. _u _.__ ~~
, USECURRENT~
DATE
by New York Domestic
W
CJ)
Z
W
()
::i
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
~
{ SEAL }
'-.-'
YEAR
MONTH
YEAR
TIME
MONTH
NAME (PRINT)
SIGNATURE.
MAILING ApDRESS
10:07 ~~ 02
24
2005 04
24 2005
ZIP
I TAT
26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
TIME MO. DAY YEAR 0 ~ELlGIOUS
AM I !1 ,-
:30 PM :;J W:::J 9 0 OTHER, SPECIFY
,..,,\tr~~:::il M/~ I ~~Mav:~ S',.
SIGNATURE. ~g'.J/f~;;.~j_~ ~%r
MAILING ADDRESS !/ I
/57j 11J--~{ IJ1J .'eu) ~~
STREET CITYfTOWN
30. WITNESS TO ~MONY
NAME (PRINT)
28. PLACE WHERE MAHRIAGE OCCURRED
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
10 CIVIL
A. STATE NEW YORK B. COUNTY
\),1+tkt~~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY /0 C/{;/f ~ E E jJ 5 /'e
SIGNATURE.
DOH-98 (11/98)
TITLE ?&tSt-ot'"
DATE 3//3 /O~-
tJ.pJAJ cjpt- /1-.,60
STATE/' ZIP
31. WITNESS TO EREMONY
Y\~-I+.f'
NAME (PRINT)
SIGNATURE.