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COUNTY Dlltchess
CITYITOWN Wappinger
~~J~~(iT 1368
~~~~J~R 74
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
~m Spar.aaIl91\R~~URNAME
FIRST
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~
1. A. FULL NAME
11. A. FULL NAME
~e A Pint~RRENT SURNAME
FIRST
ll.
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. S~~~~\~M';:~~~t~~C~~SE) ~paraGioo
D. SOCIAL SECURITY NUMBER 116-5& 3799
12 RESIDENCE A. NmMEYOrk B. ~E
C. CHECK ONE 0 CITY o.,IfOWN 0 VILLAGE
AND 'Ab. .
SPECIFY v_pp1nger
D. STREET ADDRESS 14H V\lhtte Gatt Drive ZIP 12590
8 BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
IOPTIONAL . SEE REVERSE)
D SOCIAL SECURITY NUMBER 11~5fJ..OJ12
2. RESIDENCE A.~~Xork B ~es:l
C CHECK ONE 0 CITY CinOWN 0 VILLAGE
AND Wa.
SPECIFY ppnger
D. STREET ADDRESS 14H VVhIte Gate Olive ZIP
12590
YES [iI' NO
/
y1S60
13.8. DATE OF BIRTH
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES [J,'NO
Mo1Q / 43 /.j D6l
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
MON'~ / ~~
3. A. AGE 43
4. EMPLOYMENT
13. A. AGE 36
14. EMPLOYMENT
38. DATE OF BIRTH
A. USUAL OCCUPATION Rail Road Supervisor
8. TYPE OF INDUSTRY OR BUSINESS Metro North
5. PLACEOFBIRTH~oY.
6. FATHER
A. NAME Joseph Spar:aano
8. COUNTRY OF BIRTH Italy
7. MOTHER
A. MAIDEN NAME Rosine Monetto
8. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
A. USUAL OCCUPATION Cashier
B. TYPE OF INDUSTRY OR BUSINESS Thl#ty Beverage
15. PLACE OF BIRTH -i~/~YY~SA)
16. FATHER
A. NAME Edward PiRter
8. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Therese Me Cabe
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 4
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
DEATH
100
B. HOW DID LAST MARRIAGE END? (3) []jIbIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 08/ Nl / ~
MONTH DA""" ......
D. ARE ANY FORMER SPOUSE(S) ALIVE? [)ItES 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
000
8. HOW DID LAST MARRIAGE END? (3) OlI!lIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? ~ / -'A / ")IV\~
MONTH ~ DJ!f'iI ~'iI
D. ARE ANY FORMER SPOUSE(S) ALIVE? o;ES 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
08lO8l2OO3 ~ *.:Yonc 0 Oil' 1ST 0l01/1e80 PoughkeepsIe, Nev-:YOFk 0." 0
o 0 2ND 03!1011995 Poogr.keeJBiB, N..-: York 0 ClJf'
o 0 3RD 03I28l2003 0l1ch.. County, NewYnrk 0 ClJf'
o 0 4TH'" 0 0
y knowledge and belief that the information I provided is true and that I de al impediment exists
\...
. SIGNATURE OF BRIDE ~
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23. SUBSCRIBED AND SWORN ORE E
SIGNATURE OF TOWN OR CITY CLERK ~ DATE CflIf1lI2OO4
This license authorizes the marriage in New York State authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within N 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
r-"-,
{ SEAL }
'-v-I
NAME (PRINT)
SIGNATURE ~ --
MAILING ADDRESS
MONTH
YEAR
YEAR
MONTH
07
P8
09
05 2004
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNTY Q.J.TaJ.eS5
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o VILLAGE OF