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COUNTY Dutchess
,CITYfTOWN Wappnger
S~J:~CRT 1388
~G~~J~R 113
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Donald P. Stroffolino
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~h~nhAnip- ~ KlJn~
M!i5DLE CURRENT SURNAME
.-J
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
8. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) OilS-52 3365
D. SOCIAL SECURITY NUMBER - --. --
2. RESIDENCE A. New York B. DutchP-ml.
(STATE) (COUNTY)
C. CHECK ONE 0 CITY [JI'TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STRm ADDRESS 64 Soook Hili Road
8. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE ~n1inn
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER nRQ..fV.Rll1R
12. RESIDENCEA. NewVorlr B. nll.~
(STATE) ~
C. CHECK ONE 0 CITY ~OWN 0 VILLAGE
AND Wa .
SPECIFY ppnger
D. STREET ADDRESS 84 Spook Hili Road ZIP 1,)5M
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
13. A. AGE 40 13.B. DATE OF BIRTH M~ / "nt ~~
14. EMPLOYMENT
A. USUAL OCCUPATION C'.omputer OppJs:Jtor
B. TYPE OF INDUSTRY OR BUSINESS VonltArIo B^Ard Of Ed
15. PLACE OF BIRTH ~~~lfJli,u_ ,X~
16. FATHER
A. NAME Genr~ .John Kunr.a
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Carol ARn PrMlR.r
B. COUNTRY OF BIRTH II S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
ZIP
12590
YES r! NO
/JiEiO
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
3. A. AGE 44 3B. DATE OF BIRTH M / 17
MONTH DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Musician
B. TYPE OF INDUSTRY OR BUSINESS Self - EmplQyed
5. PLACE OF BIRTH Mount Klsco. New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Donald Martin Straffalino
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME AArbAfA plath flJoe
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
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9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) cfDIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 06 / 15 / 2004
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 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
1 ST 0611512004 PolV'kMpsIe. New Vark
2ND
3RD
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDEIOl? / /
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
DEATH
DEATH
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o
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21. SIGNATURE OF GROOM ~
22. SIGNATURE OF BRIDE ~
USE CUR ENT NAME
23 ~::;J~~~Do~N.fo~~06': ~<ivB~Ef:~~E DATE MInRI'.XK14
This license authorizes the marriage in tate of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies wi in 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
{ } NAME (PRINT) Gloria J. M
TIME MONTH
SEAL SIGNATURE ~
MA~&i~
"-.,,-I STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
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YEAR
11:42AM 09
PM
ZIP
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYD4K..u?s>
1 'tf.. CIVIL
29. OFFICIANT
NAME (PRINT)
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 'rf.... TOWN OF 0 VILLAGE O~
SPECIFY !tA5 r Pi Sit /(14.L.
SIGNATURE ~
MAILING ADDRESS
SIGNATURE ~
DOH-98 (11/98)
NAME (PRINT)
SIGNATURE ~
