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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROQM
Gerald T. Fossati, Jr.
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 !l11 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 CltsICJiM J. Morse 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
Dutchess
COUNTY \Nappi
CITYfTOWI:lI368 nger
DISTRICT '1
~~~I~~~R 123
NUMBER
1. A FULL NAME
MIDDLE
CURRENT SURNAME
FIRST
"-
N
B BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL, SEE REVERSE) 105-56-2938
D. SOCIAL SECur:fVUMBER DutCheSS
2. RESIDENCE A. (STATE)" 8. (COUNTY)
C. ~m5CK ONEWaPPi~P TOWN 0 VILLAGE
SPECIFY 2418 Rouh:. 9 0
D. STREET ADDRESS ZIP
E. IS RESI~E WITHiN LIMITS OF CITY OR INCORPORATED '6liGE? 1 Ii
3. A. AGE 38. DATE OF BIRTH /
MONTH DAY
12S0
.;
Y/ ~9lEi1
YEAR
4. EMPLOYMENT
Steam Fitter
~1838
B. TYPE OF INDUilO6M~, NtM York
5. PLACE OF BIRTH
(CITY. STATE/COUNTRY IF NOT USA)
A. USUAL OCCUPATION
6. FATHER
A. NAME
Gerald Thomas Fossati, Sr.
USA
8. COUNTRY OF BIRTH
7 MOTHER
A. MAIDEN NAME
Beryl Adele Van We
USA
2
B. COUNTRY OF BIRTH
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO,CE CIVIL AN~LMENT
DEt)H
,;
B. HOW DID LAST MARRIAGE END? 13) 0 D1VOR<Q7 (3) 0 ~ULMENT 2fli2DEATH
C. DATE LAST MARRIAGE ENDED? ~ / /
MONTH'I" DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10,
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21. SIGNATURE OF GROOM ~
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SIGNATURE ~
DOH-98 (11/98)
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Unda A Russell
11. A. FULL NAME
FIRST MID~ CURRENT SURNAME
B BIRTH NAME (MAIDEN NAME). IF ~o:~Bti Santo
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 1 O/-~~;l"",j
D SDCIAL SEC~VUMBER
12 RESIDENCE A B Dutchess
(STATE)" (COUNTY)
C. CHECK ONi'u__lJ CITY 0 TOWN 0 VILLAGE
AND VVII~nger
SPECIFY 2478 Route 9 0
D. STREET ADDRESS
ZIP
12590
.;
Y)$~O
YEAR
E. IS RES!!CE WITHIN LIMITS OF CITY OR INCORPORATED~AGE? 0
13. A. AGE 13.B. DATE OF BIRTH ~
MONTH DAY
14. EMPLOYMENT
A USUAL OCCUPATION Real ~=
8. TYPE OF INDU~11I6w York:
15. PLACE OF BIRTH '
(CITY. STATE/COUNTRY IF NOT USA)
16 FATHER Thomas De Santo
A NAME USA
8. COUNTRY OF BIRTH
17, MOTHER Irene Pellechla
A. MAIDEN NAME USA
B. COUNTRY OF BIRTH 2
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVfRCE CIVIL AN'O'LMENT
DE.t)'H
~
..
B. HOW DID LAST MARRIAGE END? (3) 0 D1VOAJj~ (3) C(trULMENT 1 ~ DEATH
C. DATE LAST MARRIAGE ENDED? MONT~ / 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
(~~1N~) NWV~ea:RY'" ~r USA) SELF SPOU~
1ST '0 0
2ND 0 0
3RD 0 0
o 0
at no legal 1m e en! exists
DATE
by New York Domestic
TIME
MONTH
YEAR
12:56~~ 09
28. PLACE WHERE MARRIAGE OC~. 1-
A. STATE NEW YORK 8. COUN~
C, LOCATION OF CEREMONY
(CHECK ONE AND ~IFY)
o CITY OF ~WN OF 0 VILLAGE OF
"",Y ..::MrJ;tJ.. ~"u
NAME (PRINT)
SIGNATURE ~