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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Jerry Molinelli
MIDDLE CURRENT SURNAME
Gennaro Gerardo Salaro
23. SUBSCRIBED AND SWORN TO BE~ RE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York bride and groom named above by any
Relations Law ~11 to perform marriage ceremonies wit n 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 CLEf:!K 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) Glona .
TIME MONTH
SEAL SIGNATURE ~ TE
'-v-' MAI:2ti' ~r&j~h R AM 09
STREET ATE ZIP 03:09PM
I CERTIFY THAT I SOLEMNIZED CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
COUNTY Dutchess
c:rmOWN Wal)l:llnger
DISTRICT 1~O
NUMBER ~
~Q~'~l~R 116
1. A. FULL NAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 1~. .c-n0286
D. SOCIAL SECURITY NUMBER ~~
2. RESIDENCE A. New York B. Dutchess
(STATE). (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN c1'VILLAGE
~~~CIFY Wappingers Falls
D STREET ADDRESS 20 West Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? cI YES 0 NO
10 / 12 / 19n
MONTH DAY YEAR
3. A. AGE 26
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION WarehoLBe Operator
a. TYPE OF INDUSTRY OR BUSINESS Thomas 0' Miller Co.
5 PLACE OF BIRTH North Tarrvtftwn, New York
(CITY, STATElCOUNfR~'~OT USA)
6. FATHER
A. NAME Gerardo Salaro
a. COUNTRY OF BIRTH ItalY
7. MOTHER
A. MAIDEN NAME Sharon E. Roes
B. 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
o
a. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
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
YEAR
1ST 0 0
a: 2ND 0 0
W
III 3RD 0 0
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NAME (PRINT)
SIGNATURE ~
nrn-l_QR 111 lOA'
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Renee L Roe
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Roe . Molinelli
(OPTIONAL - SEE REVERSE) 41 n39-2747
D. SOCIAL SECURITY NUMBER .,.
12. RESIDENCE A. New York 8. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN c::/lI'l.IILLAGE
~~~CIFY WaPDinaers Falls
D. STREET ADDRESS 20 West Main street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? cr' YES 0 NO
13. A. AGE 26 13.a. DATE OF BIRTH DB /16 AQ7R
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION AccIB. Payablel Receivable
B. TYPE OF INDUSTRY OR BUSINESS Poughkeepsie Nissan
15. PLACE OF BIRTH Nashville. Tennessee
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Michael A Roe
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Anne Pel18tt1eF'@
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
a. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
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
o 0
o 0
o 0
legal impediment exists
09JD9I2004
by New York Domestic
YEAR
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNT~~
~,c. f',.e 1Gr;r
i/~f-'
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) .
o CITY OF 0 TOWN OF ~;GE OF
SPECIFY WItf'f'INGG'.6 F;:Jt:.L5
31.
NAME (PRINT)
SIGNATURE ~