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COUNTY Dutchess
CITY/TOWN \^!appinger
~~J~~c~ 1368
~5~I~J~R 26
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
~en D. GeJ'l~ SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
1. A. FULL NAME
FROM THE BRIDE
11. A. FULLNAME FIRST 19rr&M~ M. P8~RNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT ii\t.iano
c. S~S~~\~M~~~~~e~~SE) G8F8ci
D. SDCIAL SECURITY NUMBER 092-.6Q.-163O
12. RESIDENCE A. ~Si(TE) B. ~ess
C. CHECK ONE D CITY D .,::JWN D VILLAGE
AND \AIa'
SPECIFY Y\ pplnger
D STREET ADDRESS 5.:.Mexwell P1a~ ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED ~ILLAGE? D YES o./No
13. A. AGE 36 13.B. DATE OF BIRTH Moal / ~ /1~
14. EMPLOYMENT
FIRST
ll.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
057 -.6tJ.. 3464
fil'YrE) B. ~8SS
D ClTYo.,rOWN D VILLAGE
Wappinger
D STREET ADDRESS 5 Maxwoll Place ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES o.;NO
3. A. AGE 36 3B. DATE OF BIRTH ~ / 0115 / Y~~
4. EMPLOYMENT
2. RESIDENCE A.
C. CHECK ONE
AND
SPECIFY
A. USUAL OCCUPATION Radio Sales! Ad\~er.tising
B. TYPE OF INDUSTRY OR BUSINESS Cumulus BroadcastiAg, lAC
5. PLACE OF BIRTH (~ I)'~)
6. FATHER
A. USUAL OCCUPATION Rwerse Mortgage Loan Ole.
B. TYPE OF INDUSTRY OR BUSINESS BaRk Of New York
15. PLACE OF BIRTH (~~_JMX~
16. FATHER
A. NAME Josept:l Patrick Geraci
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Barbera Ann Gleek
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
A. NAME Richard J. Biviano
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Carol LOFfOlne Maim
B. COUNTRY OF BIRTH USA
1B. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
DEATH
o
o
o
(2) D DEATH
1 0 0
B. HOW DID LAST MARRIAGE END? (3) D 'IlI\tORCE (3) D ANNULMENT (2) D DEATH
C. DATE LAST MARRIAGE ENDED? 07/" 8 / ..~
MONTH OA'I Y~
D. ARE ANY FORMER SPOUSE(S) ALIVE? D ~S D 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
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) D ANNULMENT
/ /
MONTH OAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF OECREE PLACE ISSUED AGAINST WHOM
(MONTH, OAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I, being duly sworn, depose ~say:rha to the be
as to my right to enter into the martlag& .
21. SIGNATURE OF GROOM ~
D
D
D
07/18/1996 New City, N&\&J Y oFk
D
D
D
23. SUBSCRIBED ANO SWORN TO BEFORE E
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11 to perform malTiage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
D 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
DATE
by New York Domestic
,-"-,
{ SEAL}
~
NAME (PRINT)
YEAR
MONTH YEAR
TIME
MONTH
08:s.t~
04
09
06 07 2004
CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~
LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF D TOWN OF ~ VILLAGE OF
SPECIFY tQl'? 1.#'d1it1' /ifiLJ
S ET
~ .rrN~"O ~-:j
NAME (PRINT) ,c...4cp-
SIGNATURE ~ ~
DOH-9B (11198)
EI/;.op
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