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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Francis R. Di Martino
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYITOWN Wappinger
SJsJ:k~ .1388
R~-.lISTER 95
NUMBER
1. A. FULL NAME
FIRST
Q.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 117-60-9357
D. SDCIAl SECURITY NUMBER
2. RESIDENCEA. ~York B. ~
( AE) ( )
C. CHECK ONE 0 CITY ~OWN 0 VILLAGE
AND We.
SPECIFY pplngeI'
D. STREET ADDRESS 8 Erin sue DrIve
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE :15 3B. DATE OF BIRTH nR /
MONTH
ZIP 12590
DYES cY' NO
11 / 1QRQ
DAY YEAR
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4. EMPLOYMENT
A. USUAL OCCUPATION Oliver
B. TYPE OF INDUSTRY OR BUSINESS 0 H L
5. PLACE OF BIRTH T.rNttlAAIn~~ York
(CITY: s"A~~MTRY IF NOT USA)
6. FATHER
A. NAME Pasquale Oi Martino
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME ElnbMh RlI~
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
(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
1D. 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
M!~1y R H-rURRENT SURNAME
-1
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Di Martino
(OPTIONAL - SEE REVERSE) 110.7" DnDA
D. SDCIAlSECURITYNUMBER __~
12. RESIDENCEA. NAwVork B. Dllt~
~~ (~
C. CHECK ONE 0 CITY (JIIIltOWN 0 VilLAGE
AND 'A'" .
SPECIFY "".ppoger
D. STREET ADDRESS 8 Erin Sue DrIve ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r!I NO
13. A. AGE 31 13.B. DATE OF BIRTH MJ.r~i ~~
14. EMPLOYMENT
A. USUAL OCCUPATION optometrist
B. TYPE OF INDUSTRY OR BUSINESS V. A. Hud. VAlI~ H C S
15. PLACE OF BIRTH ~N~ Vork
16. FATHER
A. NAME Lester ~
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME .JMnne Muller
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
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
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o 2ND
o 3RD
o 4TH
ief that the in ormation I provided is true and that I decla
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DATE 08I11f.lOO4
Falls NY 12590
OWN SATE
27. TYPE OF CEREMONY
o ~ RELIGIOUS
9 0 OTHER, SPECIFY
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TITLE
SIGNATURE ~
DOH-98 (11/98\
22. SIGNATURE OF BRIDE ~
by New York Domestic
TIME
MONTH
YEAR
ZIP
11 :31AM
PM
08
10 CIVil
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY PrJ'TN/41
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~ VILLAGE OF C"~
S~fll"',
'vi{ tA1J. y
C L 5-112 6y A? iii JtI
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;t'Y / oS-Ie,
TATE
NAME (PRINT)
SIGNATURE ~