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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Scott P. Vitulli
COUNTY DutchesS
CITYITOVl{N Wappinger
~~J~~CRT 1368
~5~'~J~R 123
1. A, FUll NAME
FIRST
MIDDLE
CURRENT SURNAME
ll.
N
S, BIRTH NAME, IF DIFFERENT
C, SURNAME AFTER MARRIAGE
(OPTIONAl - SEE REVERSE) 073-64-9734
0, SOCIAL SECURITY NUMBER
2, RESIDENCE A, New York B, Dutchess
(STATE) wi. (COUNTY)
C, CHECK ONE 0 CITY 0 TOWN D-VllLAGE
0, :~:~;ADDR=~~ar::~~~nue ZIP 1258D
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 ~ES 0 NO
3, A, AGE 31 3B, DATE OF BIRTH 08 / 09 / 197
MONTH DAY YEAR
4, EMPLOYMENT
A, USUAL OCCUPATION pastry Chef
B, TYPE OF INDUSTRY OR BUSINESS The waterVlew
5, PLACE OF BIRTH Town Of Cor1Ianclt, New York
(CITY, STATE/COUNTRY IF NOT USA)
6, FATHER
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A. NAME Anthony Daniel Vitulli
B. COUNTRY OF BIRTH USA
7, MOTHER
JQyce Helene Webb
B, COUNTRY OF BIRTH USA
8, NUMBER OF THIS MARRIAGE 1
A, MAIDEN NAME
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) 0 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
FROM THE BRIDE
Tammy L Roberts
MIDDLE CURRENT SURNAME
~
, " A, FUll NAME
FIRST
s, BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C, SURNAME AFTER MARRIAGE Vitulli
(OPTIONAL - SEE REVERSE) 076-72-2338
0, SOCIAL SECURITY NUMBER
12, RESIDENCE A, New York B, Dutchess
(ST A TEl wi (COUNTY)
C, CHECK ONE 0 CITY 0 TOWN 0 "'VILLAGE
~~~CIFY Wappingers Falls
0, STREET ADDRESS 31 Clapp Avenue ZIP 12580
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? D~ES 0 NO
08 / 18 /1970
MONTH DAY YEAR
13, A, AGE
34
13,B, DATE OF BIRTH
14, EMPLOYMENT
A, USUAL OCCUPATION Account Corrcinator
B, TYPE OF INDUSTRY OR BUSINESS Estee Laueler services
15, PLACE OF BIR~-J(Jtwztnn. New York
l~n ,~~~TRY IF NOT USA)
16, FATHER
A, NAME MarshaH Rober1B
B, COUNTRY OF BIRTH USA
17, MOTHER
A, MAIDEN NAME VIvIan Vltarlus
B, COUNTRY OF BIRTH USA
1
18, NUMBER OF THIS MARRIAGE
19, PREVIOUS MARRIAGES
A, NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
o 0
DEATH
o
B, HOW 010 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
1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, that
as to my right to enter into the marriage
21, SIGNATURE OF GROOM ~ '
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
ge and belief that the information 1 provide
f
o 0
o 0
o 0
o 0
al impediment exists
23, SUBSCRIBED AND SWORN TO BEFORE 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 with' New York State, THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is 0 be used only for the purpose of a second or subsequent ceremony.
~ 24, TOWN OR CITY ClERIS 25. A, SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) GlOIla J. Morse
{ ~ ~
SEAL SIGNATURE ~
'-v-' MAll:!D'tIMebush 11 :23M 09
STREET ZIP PM
I CERTIFY THAT I SOLEMNIZED ~
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE 1 CIVil
DATE AND AT THE TIME AND
PLACE INDICATED.
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by New York Domestic
YEAR
28, PLACE WHERE MARRIAGE OCCURRED
A, STATE NEW YORK B. COUNTY
J../~
:fJi) ~ / I) ~Y "Y
~~~t~~~~~T~'" . 1~~K4c1/1~t9f(' TITLE
SIGNATURE~ ~~_ DATE
MAILING ADORES 7./
~i~ WAu- ~ K~.fJ,?.snw ;fly
STREET CITYITOWN
30, WITNESS TO CEREMONY
NAME (PRINT) C/-I Il~ J(. CiI.i/sn~trJA.J
SIGNATURE~ ~,( ~
nnl-l_QA 111 /OA\
V t,}!1if/L .[ c.h'~
/O/2Y/Olf
I .
/ ~90 I
C, lOCATION OF CEREMONY
(CHECK ONE AN~CIFY)
o CITY OF iit'TOWN OF 0
SPECIFY E StJ fJJ.l S.
VilLAGE OF
STATE
31.