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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Craig Falgiano
MIDDLE CURRENT SURNAME
23. SUBSCRIBED AND SWORN TO BEFORE
SIGNATURE OF TOWN OR CITY CLER
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
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 cc;rcifi~. Morse 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
TIME YEAR
SEAL SIGNATURE ~ DAT~15f2003
'-y-I "20 Falls, NY 12590
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
COUNTY Dutchess
CITYITOWr;j, waPPInger
DISTRICT 1368
NUMBER
REGISTER 126
NUMBER
1. A. FULL NAME
FIRST
0-
N
8. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE .
(OPTIONAL - SEE REVERSE) 092-60-6112
D. SDCIAL SEC~TVUMBER
2 RESIDENCE A. 8. Dutchess
(STATE) Ii (COUNTY)
C ~~6CK ON~ D. CITY 0 f?8jiS D VILLAGE
SPECIFY pplngefS
D. STREET ADDRESS 31 South Avenue ZIP 12590
E. IS RES~CE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
3. A AGE 3B. DATE OF BIRTH 02 /27 /1963
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Auto Mechanic
B. TYPE OF INDU~MicS'iClWN~arnson Repelrs
5. PLACE OF BIRTH ,York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A_ NAME Arnold Falgiano
B. COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Rosemarte Prestle
B. COUNTRY. OF BIRTH U ~ A
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVrCE CIVIL AraULMENT
~
B. HOW DID LAST MARRIAGE END? (3) 0 DIVO& (3) ~NULMENT ~ DEATH
C DATE LAST MARRIAGE ENDED? / /1
MONToIlI' DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
1 5T ~~WWi'& ~8ir;,N~Y..y NOT USA) S~F SPO~E
o
o
DEATH
o
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
C'..oIleen M PaJrDeI:
MIDDLE - UJl'\rlENT SURNAME
11. A. FULL NAME
FIRST
8. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE FaJgieno
(OPTIONAL - SEE REVERSE)
D. SDCIALSECURITYNUM8ER ~10
12. :ES~:;CCKE:NEN .~tg) CITY 0 TOWN ~VI~A~
~~~CIFY Wappingers Falls
D. STREET ADDRESS 31 South Avenue, AJt- g ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
13. A. AGE gs 13.B. DATE OF BIRTH ~H /1~AY ..
14. EMPLOYMENT
A, USUAL OCCUPATION Hairdr-er
B. TYPE OF INDUSTRY OR BUSINESS The Cutting I=dge
15. PLACE OF BIRTH Carmel New V mY
(CITY, STAT~/COUNTRY IF NOT USA)
16_ FATHER
A. NAME Leonard Kramer Palmer
B. COUNTRY OF BIRT~ S A
17. MOTHER
A, MAIDEN NAME ShAron Kay ClpoIa
B. COUNTRY OF BIRTf-lJ S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
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 0
o 0
o 0
o 0
t no legal impediment exists
DATE 0911512003
by New York Domestic
ZIP
YEAR
1
14 2003
STATE
27. TYPE OF CEREMONY
o ~ELlGIOUS
9 0 OTHER, SPECIFY
29 OFFICIANT
NAME (PRINT)
, STATE
NAME (PRINT)
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
ti)~,,,^
o
A. STATE NEW YORK B. COUNTY
C_ LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WNlFI 0
SPECIFY C~!:f..(
VILLAGE OF
31.
i a./) 0
SIGNATURE ~