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ST ATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Emanuel D' Er.llrio
MIDDLE CURRENT SURNAME
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CCUR 0
DAY YEAR 0 0 RELIGIOUS
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TITLE ."" 1-:';5 CJ S 17 t.. ~ I~ '+
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STATE ZIP
31. WITNESS TO C REMONY
COUNTY ~
CITYfTOWN Wappinger
~~J~~c~ 1388
~5~I~J~R 94
1. A. FULL NAME
FIRST
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) ~.. ~2134
D. SOCIAL SECURITY NUMBER ~--
2 RESIDENCE A. NP..w York B. Dutm-.
~) (COU~
C. CHECK ONE 0 CITY mOWN 0 VILLAGE
AND 'AI..'
SPECIFY Vv..PJln.geI'
D. STREET ADDRESS 32 Montfort Road
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE 71 3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Retired
ZIP 12590
o YES ~NO
B. TYPE OF INDUSTRY OR BUSINESS
5. PLACE OF BIRTH ManbIt:tID New York
(CITY, STATElCOUNfliy IF NOT USA)
6. FATHER
A. NAME Michele D' Erario
B. COUNTRY OF BIRT-H Italy
7. MOTHER
A. MAIDEN NAME Midi 81ntesp1lto
B. COUNTRY OF BIRTH It8bt.
8. NUMBER OF THIS MARRIAGE !2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
1
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) ~EATH
C. DATE LAST MARRIAGE ENDED? 11 / ~ / ~
MONTH ,gJY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES [J'IiIO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OFDECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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1ST
2ND
3RD
4TH
I, being duly sworn, depose and say. that to the
as to my right to enter i~e state.
21. SIGNATURE OF GRO
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DATE
NAME (PRINT)
SIGNATURE ~
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
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L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~f'!!raldinP- M. lan7ilntta
MIDDLE CURRENT SURNAME
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11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT "'''e
C. SURNAME AFTER MARRIAGE laft7iloHa - n' Enapo
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 1~1-~
12. RESIDENCE A. Nf,ilKEYnrk' B. ~
C. CHECK ONE 0 CITY DflIItOWN 0 VILLAGE
AND '.
SPECIFY )Nappl'lgM'
D. STREET ADDRESS 32 Montfort ROAd
ZIP 12~
YES of NO
/-j~p
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGEJ 0
13. A. AGE 64 13.B. DATE OF BIRTH M~ / ~
14. EMPLOYMENT
A. USUAL OCCUPATION Retired
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH ~ NAN VIWIt'
~O~
16. FATHER
A. NAME Nir.hol_ Mllillle
B. COUNTRY OF BIRTH US".
17. MOTHER
A. MAIDEN NAME SecI. Domllle:!
B. COUNTRY OF BIRTH USA
1B. NUMBER OF THIS MARRIAGE ~
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o
DEATH
o 1
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) D~TH
C. DATE LAST MARRIAGE ENDED? 02 / faR / ~'3
MONTH 'Dr ~
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES ~O
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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DATE nRIOQfX1(t4
person authorized by New York Domestic
TIME
MONTH YEAR MONTH YEAR
nRI09J2(XJ4
10:~M
PM
08 10 10 08 2004
ZIP
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY") l.! f c ~ -e s...
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF lli:l TOWN OF 0 VILLAGE OF
1 r& CIVIL
SPECIFY
.
W/9 r/,/N~-e;e../
NAME (PRINT)
SIGNATURE ~