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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
~~b~ael F M~!iim~JT SURNAME
1ST 01.'0412004 Br.onx, New York 0"; 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no :"\g.al:i
as to my right to enter into the marriage 7late. " .
21 SIGNATURE OF GROOM ~,/'! '~'"7l1ltZ . 22. SIGNATURE OF BRIDE ~ - N:O \\~J)
i /f'E "f \ U E CURRENT NA!AE
23 SUBSCRIBED AND SWORN TO BEFORE M~
SIGNATURE OF TOWN OR CITY CLERK ~ '- 1ft,
This license authorizes the marriage in New York State of he bride and groom named above by any person authorized by New York Domestic
Relations Law 911 to perform marriage ceremonies within 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 [)uach~
CITYfTOWN Wappinger
~~~~~cr! 1368
~5~I~J~R 5
1 A FULL NAME
FIRST
Q.
N
BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER
131~58-1587
B g~Mge
VilLAGE
2. RESIDENCE A JI.I V
fST"TE)
C CHECK ONE WCITY 0 TOWN 0
AND
SPECIFY MiddletoWfl
o STREET ADDRESS ::>1 1 D Commonwealth
ZIP 10Q40
DY"rES 0 NO
A
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE?
3B. DATE OF BIRTH
3 A. AGE 35
4. EMPLOYMENT
A. USUAL OCCUPATION Network Engineer
B TYPE OF iNDUSTRY OR BUSINESS "nemployed
5. PLACE OF BIRTH (~1M~~~ ;Yr2f~A)
6. FATHER
...
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C
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A. NAME Joseph 'Atilliam Muiane
B COUNTRY OF BIRTH USA
7. MOTHER
A. MAiDEN NAME Ulllan NJlllo
B COUNTRY OF BIRTH U S .4-
8. NUMBER OF THIS MARRiAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
,..
100
B HOW DID LAST MARRIAGE END? (3) D~VORCE (3) 0 ANNULMENT (2) 0 DEATH
C DATE LAST MARRiAGE ENDED? OY n.4 / ?nQ4
MONTH DA 'l'"" Y~ll"
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 ~S 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
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STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~inA M M::m=lfinti
MIDDLE CURRENT SURNAME
~
11. A FULL NAME
FIRST
B -BIRTH NAME (MAIDEN NAME), IF DiFFERENT Mar~finti
c. SURNAME AFTER MARRiAGE Marino
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 050-~R-79::\7
12. RESIDENCE A. N(s't.TE) 8. ?c:1~P.5l.S;
C. CHECK ONE 0 CITY 0 TOWN DIJIl&ILLAGE
~~~CIFY WRppingers FRIIs
D STREET ADDRESS 2688 West Main street ZiP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? of YES 0 NO
13 A AGE 35 13.8. DATE OF BIRTH ~ / lZ /1~Re
14. EMPLOYMENT
A. USUAL OCCUPATION Trtlp. CIp.rk/A~ PaYAble
B. TYPE OF INDUSTRY OR BUSINESS B M W Of Hudson Valley
15. PLACE OF BIRTH CnrtJAndt NfIMI York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Rnr.r.n FrAncis; MRrafinti
B. COUNTRY OF BIRTH USA
17. MOTHER
A MAIDEN NAME Phy1l1s Loretta .AJexander
8. COUNTRY OF BIRTH I I S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
o
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
o
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CJ)
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::::i
~
{ SEAL }
'-.,-'
06
2
04
05 2004
STRE
~~~R~~~RT~~~ IO~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 ~ RELIGiOUS
DATE AND AT THE TIME AND 'Ii>:IlN
PLACE INDiCATED 2: 30 PM 2 14 2004 90 OTHER, SPECIFY
~~rJti~9i~~T CHARLES E. STICKLEY TITLE CLERGYMAN
"""'""' ~ ,( M/UJI) ~t.~ ~ "" FEBRUARY 14 , 2004
MAILING ADDR~
17 MAIN ST. HURLEY W YORK 12443
STREET CITYfTOWN STATE
30. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE ~
OOH-98 (11/98)
CHRISTOPHER A PECTLE
~Q~ t. tPUic:v-
TiME
MONTH
YEAR
MONTH
YEAR
ZIP
AM
12:S(lJM
28. PLACE WHERE MARRIAGE OCCURRED
02
10 CIVIL
A. STATE NEW YORK B. COUNTY ULSTER
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECiFY)
o CITY OF Xl TOWN OF 0 VILLAGE OF
SPECIFY
'HTTRT ,F-V ,
ZIP
31 WITNESS TO CEREMONY
NEW YORK
NAME (PRINT)
SIGNATURE ~