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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Peter Scolaro
MIDDLE CURRENT SURNAME
COUNTY Dutchess
crrYrrowN WaDPInger
DISTRICT 1388
NUMBER
~5~I:l~R 105
1. A. FUll NAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) ru::.L72 ~683
D. SOCIAL SECURITY NUMBER UJ"'t"' ., ,
2. RESIDENCE A. NY ~ B. DutcheBB
(STATE). (CDUNTY)
C. CHECK ONE 0 CITY ~TOWN 0 VILLAGE
AND \A.....
SPECIFY "..PPlnaer
D. STREET ADDRESS 14 Valley Road ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VIllAGE? 0 YES r;! NO
3. A. AGE 26 3B. DATE OF BiRTH 05 / 01 / 1978
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Auto Bodv Technician
B. TYPE OF INDUSTRY OR BUSINESS Jack'l Auto Body
5. PLACE OF BIRTH Blaoon. NM York
(CITY, STATEICOUNTRY IF NOT USA)
6. FATHER
A. NAME Peter C. Scolaro
B. COUNTRY OF BIRTH It8IY
7. MOTHER
A. MAIDEN NAME KAren Ann NAvarro
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
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
Carolvn C. Hannon
MIDDLE CURRENT SURNAME
~
11. A. FUll NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Scalaro
(OPTIONAL - SEE REVERSE) .v1ta~ 4433
D. SOCIAL SECURITY NUMBER ~
12. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY d"'TOWN 0 VILLAGE
~~CIFY pouahkeeplie
D. STREET ADDRESS 37 Brlarclttr Avenue ZIP 12603
E. is RESIDENCE WITHIN UMITS OF CITY OR INCORPORATEO VIllAGE? 0 YES r5 NO
13: A. AGE 24 13.B. DATE OF BIRTH 03 /13 "..1980
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Registered Nume
B. TYPE OF INDUSTRY OR BUSINESS CIIBtIe Pcint Veterans
15. PLACE OF BIRTH DftutthlMAMle: NM York
~~IFNOTUSA)
16. FATHER
A. NAME Ravmond MMltI .vJJ Hannon
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME L.orraIne Mawy Toman
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
B. 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 1ST 0 0
o 2ND 0 0
q ~ 0 0
o 4TH 0 0
lief that the in ormation I provided is true and that I declare that no legal impediment exists
. SIGNATURE OF BRIDE '""(,L""~~\- ;'1,......... t~
~ ~~1-""~'
DATE 00/2412004
f the bride and groom named above by any person authorized by New YorK Domestic
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TIME
MONTH
YEAR
UA I E 00/2412D04
F811s NY 12590
ZIP
AM
12:26PM
08
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
SATE
27. TYPE OF CEREMONY
o rs(RELlGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY DC'/1;j I!' 5~
C. LOCATiON OF CEREMONY
(CHECK ONE AND SPECIFY)
~ITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY {3 '- ILt':..." 11
TITLE e IJ tlt/ /,'c.. {J l" I ; ,;/
DATE. ~f~. ~ J..,fJo-f
tv 'fSTATE I ~ <" D ~P
31. WITNESS TO CEREMONY
CI !TOWN
26. SOLEMNIZATION OCCURRED
TIME M. DAY YEAR
J..'3CJ~ q S" 0
29. OFFICIANT [7 "1""" J ft
NAME (PRINT) IVrI. '-1 t7~ ~ t' n tJ loS I j r1 eL.M 0
~2~~i,U~6~~Jt J.n-Jf~ !1 J"/~
"- ()l'iJ<" .s'Ou:., {31~ t:.PVl
STREET CITY fTOWN
30. WITNESS T
NAME (PRINT)
NAME (PRINT)
SIGNATURE ~