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COUNTY Dutch5S
CITY/TOWN \fIJappinger
~~~~~c~ 1368
~5~~J~R 4
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
~~is I Silvec::.tri
M L CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
L 0 SUPPLEMENTAL FILE
.-J
A. FU lL NAME
FROM THE BRIDE
Eileen F. Allen
FIRST MIDDLE CURRENT SURNAME
8. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Allen
c. SURNAME AFTER MARRIAGE Allen
(OPTIONAL. SEE REVERSE) 08':122 7317
D. SDCIAL SECURITY NUMBER --..,.. --
12 RESIDENCE A. N Y B. Dutchess
c. CHECK ONE (ST~I CITY D."fOWN 0 VILLAGE (COUNTY)
AND W .
SPECIFY applnger
D. STREET ADDRESS 1 Circle Drive
11. A. FULL NAME
FIRST
BIRTH NAME. IF DIFFERENT
C. SU RNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 062~-3760
B /J!~~~
C. CHECK ONE 0 CITY 0 TOWN otvlLLAGE
AND
SPECIFY \Mappinge~ Fen~
D. STREET ADDRESS 17 \N~ strfl!et
2 RESIDENCE A
~XTE)
ZIP
12590
YES D';NO
/1931
YEAR
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VilLAGE?
ZIP 12590
D"""ES 0 NO
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VillAGE? 0
04 /11
MONTH DAY
3. A. AGE
40
3B. DATE OF BIRTH
14. EMPLOYMENT
13. A. AGE 72
13.8. DATE OF BIRTH
MON
4. EMPLOYMENT
A. USUAL OCCUPATION Laborer
B. TYPE OF INDUSTRY OR BUSINESS Cservak Cnndrudion
5. PLACE OF BIRTH gh'~~~~~OT~~ York
6. FATHER
A. NAME John Peter Silvestri
B COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Florence Elaine Fusaro
B COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
A. USUAL OCCUPATION Retired
8. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Belle Rose. Lona Island. Ny
(CITY. STATE/COUNTRY IF NOT iTsA)
16. FATHER
A. NAME Herbert De \Mtt
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME 19villA .lAne \M'\Aaton
B. COUNTRY OF BIRTH USA
2
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (31 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (310 "ORCE (3) 0 ANNULMENT
/ / C. DATE LAST MARRIAGE ENDED? 03/ 27 /
MONTH DAY YEAR MONTH DAY
D ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 ~S 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH. DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 0 0 1ST 03/?7/198S poughkeepsie. NY 0 0";
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
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 legal impediment exists
as to my right to enter into the rTliln'age state. ~ '-6? <J /7J ,If
21. SIGNATURE OF GROOM ~ ....J:::J ' , 22. SIGNATURE OF BRIDE ~ C d.R ~ ~ 0/1/1)
USE CURRENT NAM , USE CURRENT NAME
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
DEATH
o
o
o
o
C. DATE LAST MARRIAGE ENDED?
(2) 0 DEATH
1986
YEAR
02I02l2004
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23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State 0 the bride and groom named above by any person authorized
Relations Law S11 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
DATE
by New York Domestic
02
~
{ SEAL }
'-v-I
YEAR
NAME (PRINT)
TIME
MONTH
AM
ZIP 03: 1 ptM
1~IL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNTY ~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF ~ VILLAGE OF
"
29. OFFICIANT
NAME (PRINT)
SPECIFY
r