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STATE OF NEW YORK
COUNTY Ol~ DEPARTMENT OF HEALTH
CITYfTOWN ---applnger:
~~~~~CRT 1388 . AFFIDAVIT, LICENSE and
~E~~J~R 60 CERTIFICATE OF
~ CORRECTED BY OFFICfANT'2{~MARRIAGE
,,--
FROM THE GROOM
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
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L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~
1. A. FULL NAME
~rd J. staNT SURNAME
FIRST
11. A. FUU NAME
Ly~A Thom~SURNAME
FIRST
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SDCIAL SECURITY NUMBER Q9S.42..0226
~ESIDENCE A. ~)Yofk B. !JMt~8
CHECK ONE 0 CITY WT"OWN 0 VILLAGE
AND n "~i
PECIFY roug..l~e
TREET ADDRESS 581 Sheefe Road Lot #56 ZIP 12590
. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIUAGE? 0 YES ~ NO
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT 0' .Angelo
C. SURNAME AFTER MARRIAGE st8fiti
(OPTIONAL - SEE REVERSE)
D. SDCIAL SECURITY NUMBER 120-46-2266
B. ~~ess
VILLAGE
12. RESIDENCE A. MY
~ATE)
C. ~6CK ONE 0 CITY o""OWN 0
SPECIFY Poughkeepsie
D STREET ADDRESS 581 Sheefe Road Lot #66
ZIP 125;0
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES [J,'NO
McJD / Q5 ~a52
3B. DATE OF BIRTH
13.B. DATE OF BIRTH
A AGE 53
4. EMPLOYMENT
A. USUAL OCCUPATION Calpenter
B. TYPE OF INDUSTRY OR BUSINESS Manfredi COASt.
5. PLACE OF BIRTH I:lP"""y tJeuI v........
~EI~(~SA)
6. FATHER
13. A. AGE 51
14. EMPLOYMENT
A. USUAL OCCUPATION Process OpeFStor
B. TYPE OF INDUSTRY OR BUSINESS Philips
15. PLACE OF BIRTH ~AY~~HIVJ York
16. FATHER
A. NAME Richard Stenti
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME GraGe Kelbter
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 4
9. PREVIOUS MARRIAGES
A. NUMBER Of' PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
A. NAME Ridlar-d or ft-..ngela
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Joen V..'alsh
B. COUNTRY Of' BIRTH U S .\
lB. NUMBER OF THIS MARRIAGE :2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
DEATH
300
B. HOW DID LAST MARRIAGE END? (3) Olll!lIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 07--/ M / ..~
MONTH OA~- YI!ml-"
D. ARE ANY FORMER SPOUSE(S) ALIVE? [)rII'Es 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
1 0 0
B. HOW DID LAST MARRIAGE END? (3) O'lfllVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? ,..., / t\A / "00'7
MONTH V-I oM'"' _,
D. ARE ANY FORMER SPOUSE(S) ALIVE? or,ll'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
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11/25/1980 Poughkeepsie, NMVYOFk
10fl6f1987 Poughkeepsie, J!JeL..: YOOc
1ST
2ND
3RD
4TH
I, being duly sworn, depose and S
as to my right to enter into the m
o 1 ST 07 JOB/1991 DutGhes6 COUnty N8IJ: 0.; 0
[JI,I 2ND'" 0 0
[JI,I 3RD 0 0
o 4TH 0 0
d belief that the information I prOVided~iS true and that I ~e that no legal impediment exists
22. SIGNATURE OF BRIDE _'11 d Q ~(J)nab b7>
USE c R~E
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage. tate of the bride and groom named above by any person authorized by New York Domestic
Relations Law 911 to perform marriage ceremonies wit n New 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
21. SIGNATURE OF GROOM ~
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MONTH
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A. STATE NEW YORK B. COUNTY j)tlTc.lI.'SJ
C. LOCATION OF CEREMONY
(CHECK ONE ANO SPECIFY) \'1.1\ \
!;J..eITY OF 0 TOWN OF 0 VILLAG~ OF ';V
SPECIFY 1:P.Ac..O~1 AJ 'I
06
17
08
15 2004
STR
I CERTIFY THAT I SOLEMNIZE
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
ZIP
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29. OFFICIANT
NAME (PRINT)
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/98)
NAME (PRINT)
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DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
D 1ST 071OBl199'1 DutGh8B8 COOnty NtJ\.-/ Do; D
0.; 2ND'" D D
0.; 3RD D D
D 4TH D D
d belief that the information I provided :::z,and that I nre that no legal impediment exists
22. SIGNATURE OF BRIDE ~/l cia ?/ft'JJ?1ab 1m
(J USE C R~E
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage tate of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies wit 'n New 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
COUNTY Olltchess
CITYfTOWN' Wappinger
~J:k~T' 1368
~~~~J~R 60
1. A. FULL NAME
~ar:d J. stUNT SURNAME
FIRST
0-
N
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER Q95-42..0226
2. RESIDENCEA.__lyol1c B. ~_Il
C. CHECK ONE D CITY o"rrOWN D VILLAGE
AND n ...~ .
SPECIFY rOugll~psIe
D. STREET ADDRESS 567 Sheefe Road lot #56 ZIP 12590
E. IS RESIDENCE WITHIN LIMITS DF CITY OR INCORPORATED VILlAGE?
D YES [],I' NO
3B. DATE OF BIRTH
3. A. AGE 53
4. EMPLOYMENT
A. USUAL OCCUPATION Carpenter
B. TYPE OF INDUSTRY OR BUSINESS MIRfrtcl CoR&t.
5. PLACE OF BIRTH ~Ei~ YmSAI
6. FATHER
MO
A. NAME Richard stem;
B. COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME GreGe I<GIl$ter
B. COUNTRY OF BIRTH U $ A
8. NUMBER OF THIS MARRIAGE -4
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
3 0 0
B. HOW DID LAST MARRIAGE END? (3) ~IVORCE (3) 0 ANNUUMENT (2) 0 DEATH
C DATE LAST MARRIAGE ENDED? 01/ rIA / 1~
. MONTH DA"'- Y!ml.....
D. ARE ANY FORMER SPOUSE(S) ALIVE? OIPES D 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
11125/1980 Poughkeepsie, Ne\\'YOFk
10f.26/1987 Poughkeepsie, ~JeI:: Yark
21. SIGNATURE OF GROOM ~
1ST
2ND
3RD
4TH
I, being duly sworn, depose and S
as to my right to enter into the m
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{ SEAL}
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NAME (PRINT)
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~
11. A. FULL NAME
LYom&A Thom~T SURNAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT 0' .A-ngelo
C. S~S~~~cM'Z~~~t~~e~~SE) stemi
D. SOCIAL SECURITY NUMBER 12G-46-2266
12. RESIDENCE A. Ny,.ATE) B. ~_El
C. CHECK ONE 0 CITY D,.;rOWN 0 VILLAGE
AND n hkee.
SPECIFY rOug psae
D. STREET ADDRESS 567 Sheaf. Road Lot #56 ZIP 125iO
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES [lIi'NO
MOU~ / Q5 ~~
13. A. AGE 51
14. EMPLOYMENT
13.B. DATE OF BIRTH
A. USUAL OCCUPATION P-r0G8SEl Operator
B. TYPE OF INDUSTRY OR BUSINESS Philips
15. PLACE OF BIRTH ~AY~kf~NIvt York
16. FATHER
A. NAME Richar-d 0' Angelo
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Joan Walsh
B. COUNTRY OF BIRTH U S .A,
18. NUMBER OF THIS MARRIAGE :2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
1 0 0
B. HOW DID LAST MARRIAGE END? (3) D'IfI1VORCE (3) D ANNULMENT (2) D DEATH
C. DATE LAST MARRIAGE ENDED? Q" / Nl / ..00"
MONTH I oM- ~ I
D. ARE ANY FORMER SPOUSE(S) ALIVE? DIllI'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
TIME
MONTH
YEAR
MONTH
YEAR
ZIP
17
08
15 2004
06
28 PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY j)UTL4eSJ
C, LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
~ITY OF D TOWN OF 0 VILLAGE OF
SPECIFY bAc.O~J"; "
RELIGIOUS 1 ~L
9 D OTHER, SPECIFY
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SIGNATURE ~
DOH.98 (11/98)
NAME (PRINT)
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VILLAGE JUSTICE COURT
7 Mill Street
Wappingers Falls, N.Y. 12590
phone 845-297-6777
fax 845-298-6057
July 27, 2004
To Whom It May Concern:
o 233(=ffo~ ""
Please be advised that I perfonned.a civil marriage ceremony for Richard J. Steriti and Lynda A.
Thompson (Register number 60).
I made an error on the date of solemnization and the date of my signature. It should have been
July 17, 2004.
Very truly yours,
C)~ tl.1'J!fi)-d/
Charles V. McDonald,
Village Justice
RECEIVED
JUL 2 8 2004
TOWN CLERK
VILLAGE JUSTICE COURT
7 Mill Street
Wappingers Falls, N.Y. 12590
phone 845-297-6777
fax 845-298-6057
July 27,2004
To Whom It May Concern:
Please be advised that I performed a civil marriage ceremony for Richard J. Steriti and Lynda A.
Thompson (Register number 60).
I made an error on the date of solemnization and the date of my signature. It should have been
July 17, 2004.
Very truly yours,
O)J" tl.l!frtJ-d/
Charles V. McDonald,
Village Justice
RECEIVED
JUL 2 8 2004
TOWN CLERK
~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section '
} 55:
DISTRICT 111368
. REGISTER 1160
Affidavit for
Correction of Marriage Record
FOR OFFICIAL NYS USE ONLY
STATE OF
COUNTY OF
State File #
Groom:
Bride:
Date Completed:
We, Richard J. Steriti
(Groom)
being severally sworn, depose and say that
and
LyndR A. Thnmp~on
(Bride/Maiden Name)
1, We reside at 567 Sheafe Road. Lot 1156 WappingerR FRll~, NplAT York l?r;QO
2, Marriage License issued by City;Town: Town of Wappinger
3, Date of Marriage
July 17. 2004
4, Error(s) appearing on record (list exactly):
a. #26 Date of Marriage Incorrect 6/17/04
b. Date signed by Charles V. Mc Donald Incorrect 6/17/04
c.
5. Correct information as it should appear (list exactly):
a. #26 Correct Date of Marriage 7/17/04
b. Date signed by Charles V. Mc Donald Correction should be 7/17/04
c.
6. Documentation Submitted:
a.
Letter from the officiant on official letterhead for Civil Ceremony
b.
Driver's Licenses
c,
Incorrect Copy of Marriage License
This affidavit with supporting documentation is being made for the
true facts and this affidavit will become a permanent record. Th
Subscribed and sworn to ~--rlf -:v,71 L/
(affirmed) befo~m~ i~S (2!,.!J,/..::z...
, #/1, j /I MA~IA GllBijlDE
Notary Public r ~~ Notary PI'blle, State,of New YM
R~B. No. OlG/5087374
NOTE C 'f' fA h " 'd f bl' 'd N Y k S t QualIfied in Dutchpss Counflr ,; 'i'.:; ,
: ertl Icate 0 ut entlclty require or notary pu IC oUtSI e ew or ta e Commission Expires Nov. 3,~.:5" - _.
(over)
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