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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Eric S. Oberpriller
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYITOWN Wappinger
... DISTRICT 1368
NUMBER
~5~'~J~R 133
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 1 nn ~ A A29
D. SOCIAL SECURITY NUMBER U~
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r!! TOWN 0 VILLAGE
~~~CIFY Wa~nS!r
D. STREET ADDRESS 30 Pippin Lane
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
10 /06 / 1979
MONTH DAY YEAR
3. A. AGE 25
38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Auto Mechanic
B. TYPE OF INDUSTRY OR BUSINESS VIsIons Of Speed
5. PLACE OF BIRTH CoDDel'as Cove. Texas
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Randall Eric Oberpriller
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Donna Elaine Jak'ed
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) o DEATH
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
I"
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
L 0 SUPPLEMENTAL FILE
.-J
11. A. FULL NAME
FROM THE BRIDE
Elena D. Calciero
CURRENT SURNAME
FIRST
MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Oberpriller
(OPTIONAL. SEE REVERSE) 4 ':lnn A"'88
D. SOCIAL SECURITY NUMBER I.AI"....L
12 RESIDENCE A. New York B Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY [jITOWN 0 VILLAGE
~~~CIFY~
D. STREET ADDRESS 30 Pippin LIne ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES Lf NO
11 /01 ,..1'985
MONTH DAY YEAR
13. A. AGE 18
13.B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Cashier
B. TYPE OF INDUSTRY OR BUSINESS \NaImart
15. PLACE OF BIRTH Yonkers. New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Robert Lawrence Caldiero
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME RMMnarle C Bat8lho
B. COUNTRY OF BIRTH USA
lB. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
t of my knowledge and belief that the information I provided is true an
o 0
o 0
o 0
o 0
ediment exists
23. SUBSCRIBED AND SWORN TO ORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York S te of the bride and groom named above by any person authorized
Relations Law ~11 to perform 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 CITY CLE~K 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) Glona J
TIME MONTH
SEAL SIGNATURE ~ DATE 10107l2OO4
'-.y-I MA~~cBitx.h NY 12590 AM 10
STREET STATE ZIP 02:59PM
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER- \,.(
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 01". RELIGIOUS
~tl~E ~~g,tlT~~E TktlME AND AM IZ> :J'D /1 '/ 9 0 OTHER, SPECIFY
29 OFFICIANT 61 T/-J U. ..-.-/ '"~f'I i- ,^ / J" 'k "".J ~
NAME(PRINT)~'~ t'f II _ TITLE J-..w,-/ ,
. . ~~ '. - J/ / t.> / 'S 0 /"0 C-/
SIGNATURE ~ ... "1' - vP'" DATE '/, /' /
MAILING A9DRESS /1? ~ " "'7 / I J ../... r: J / - HI LI 'I""~ n
/r~ D f'VVI {.... -> D vv ~/)~..t'Y I~ J v I. .-0 7 t/
STREET CITYITOWN "I /' STATE ZIP
30. WITNESS TO CEREMONY 31. WITNESS TO CEREMONY
NAME (PRINT) lY\ \ C;. \1 e \ e. W(){ de Xl
SIGNATURE~ ~-"'" JA~
21. SIGNATURE OF GROOM ~
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22. SIGNATURE OF BRIDE ~
DATE 10107f.2004
by New York Domestic
YEAR
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNT::J!.l.J'tvhc./:J
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF X TOWN OF 0 VILLAGE OF
SPECIFY WAflflJvr