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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Kurt R. MeIz
MIDDLE CURRENT SURNAME
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I, being duly sworn, depose and say, that to the best of my knowledge and belie t at the in ormation I provided is true an that I declare that no legal impediment exists
as to my right to enter into the marriage state. ~ ' ~ _
21. SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~ _.~ _. _' - J
. USE ENT NAME
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK~
This license authorizes the marriage in New York S
Relations Law ~11 to perform marriage ceremonies withi
o If checked, this license is
24. TOWN OR CITY CLERK
. J
te of the bride and groom named above by any person authorized
New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
be used only for the purpose of a second or subsequent ceremony.
25. A. SOLEMNIZATION PERIOD BEGINS
COUNTY Dutchess
CITYITOWN WaDDIng<<
DIS'tRICT 1~e
NUMBER ~
~G~lgJ~R 98
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York
(STATE)
C. CHECK ONE 0 CITY ~TOWN 0
~~~CIFY Hyde Park
D. STREET ADDRESS 33 \NhIte Oaks Road
204-48-4470
B. Dutchess
(COUNTY)
VILLAGE
ZIP 12538
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r! NO
D2 / 23 / 1974
MONTH DAY YEAR
3. A. AGE 30
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Technician
B. TYPE OF INDUSTRY OR BUSINESS l1me Werner
5. PLACE OF BIRTH Plttsbumlt. Penn&Vlvanla
(CITY, STA~NTRY IF NO~
6. FATHER
A. NAME Ferdnand E. Metz
B. COUNTRY OF BIRTH Germany
7. MOTHER
A. MAIDEN NAME UndA ~MAn
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) 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
w
en
z
w
o
::::i
NAME (PRINT)
DATE 0811
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Denise Bianchini
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE MeIz
(OPTIONAL - SEE REVERSE) ~ -~ 2812
D. SOCIAL SECURITY NUMBER U~.
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY o'rOWN 0 VILLAGE
~~CIFY Wapginaer
D. STREET ADDRESS 64 Robert L.ene ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES rf NO
D2 /18 A977
MONTH DAY YEAR
13. A. AGE 27
13.B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Insurance Sales
B. TYPE OF INDUSTRY OR BUSINESS All state Ins.
15. PLACE OF BIRTH Rrivw New York
~SfAVElCOUNTRY IF NOT USA)
16. FATHER
A. NAME Michael Anthor1y Bianchini, Jr.
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Rt'IUt UArle 01 ~ft
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
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
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
DATE
0811612004
by New York Domestic
TIME
MONTH
YEAR
ZIP
03:1ct~-oe
28. PLACE WHERE MARRIAGE ,~~~~ _
A. STATE NEW YORK B. '1t~~
STATE
27. TYPE OF CEREMONY
o ~ELlGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF d-1'<5"WN OF
t::
SIGNATURE ~