159
f-
Z
w
m
w
III
o .
...
::l
o
r
m
z
o
~
a:
f-
m
a
w
a:
w
CJ
<(
a:
a:
<(
::;
u.
o
w
~
u
u:
i=
a:
w
u
w
a:
w
r
~
m
m
w
a:
o
o
<(
>-
u.
B
w
"-
m
a:
w
In
::;
::>
z
o
z
<(
Iii
w
a:
Iii
t,)1
"-
Z :i
~ Q W
f- f- ....
~ ~ oct
3 ~ 0
::; ...-
~ 5l !:
<( u. ....
~ 0 a:
15 ~ W
Iii ~ (J
I- "'
o
z ;;
COUNTY Dutchess
CITYfTOWN Wappinger
~~J~fFi 1368
~5~~J~R 159
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
R.rt John TUIJJ&J!~RNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
fJita L OIi'JiMiRENT SURNAME
L A. FUll NAME
1 L A. FUll NAME
FIRST
FIRST
"-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Turner
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER Q69..14~7733
12. RESIDENCE A. ~S):TE) B. ~sss
C. CHECK ONE 0 CITY 0 TOWN 0 ....ILLAGE
~~CIFY Wappinger:s Falls
D. STREET ADDRESS 7 A High street ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? c:MES 0 NO
MOQJ /~"? /1~
0Si 72~2431
2. RESIDENCE A. r...l V B n. "Mess
~TIfTE) . (eOfINl"l'J' .
C. x~gCK ONE 0 CITY 0 TOWN ~ILLAGE
SPECIFY \NappingelS Falls
D. STREET ADDRESS. 7 A High street
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE?
3B. DATE OF BIRTH
13.B. DATE OF BIRTH
ZIP
13. A. AGE 21
14. EMPLOYMENT
A. USUAL OCCUPATION Secretary
B. TYPE OF INDUSTRY OR BUSINESS Hem ng SaNtation
15. PLACE OF BIRTH (PJ!~.~t~-M!JW York
16. FATHER
3. A. AGE 21
4. EMPLOYMENT
A. USUAL OCCUPATION Laborer
8. TYPE OF INDUSTRY OR BUSINESS Hemng Sanlt8tion
5. PLACE OF BIRTH (~J'j~Wi YoRe
6. FATHER
A. NAME RobeR John Tumel=, JI=.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Jemie L YJe5tfall
8. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
A. NAME Emesto Antonio OlivieJi
B. COUNTRY OF BIRTH Italy
17. MOTHER
A. MAIDEN NAME CoAeette 8USE1n Romasoo
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
DEATH
o
(2) 0 DEATH
o
o
o
(2) 0 DEATH
o
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ ./
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) SEUF SPOUSE
o 0
o 0
o 0
o 0
no legal impediment exists
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOULOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SEUF SPOUSE
W
en
z
W
(J
:::::i
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~H 0 0 ~H
I, being duly sworn, depose and say, that tD the best of my knDwledge and belief that the information I provided is true and that I declare
as to my right tD enter into the~ -r::
21. SIGNATURE OF GROOM ~ USE CURRENT ME
23. SU8SCRIBED AND SWORN TO BEFORE ME
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 marriage 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 urpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
DATE 12lO512OO3
by New York Domestic
~
{ SEAL }
'-..,-I
NAME (PRINT)
SIGNATURE ~
MAILING ADDRESS
MONTH
YEAR
MONTH
YEAR
TIME
12
02
03 2004
06
STRE
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 B. COUNTY'~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF r! VILLAGE OF
SPECIFY1Jof(J/(l~S .foll S
29. OFFICIANT
NAME (PRINT)
..f ig L