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COUNTY -Dutchess
CITYrrOWN Wappinger
~~J~~cFi 1368
~5~I~J~R 59
~ I '"' I .. "'I I'.... I "'1.1'
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christooher R. Galente
MIDDLE CURRENT SURNAME
( J 111~ ;:,~1UA= ,.VH ;:, I A I t:: u~t: UIVL Y)
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Joanne P _ Donaghey
MIDDLE CURRENT SURNAME
~
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
0..
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Galente
(OPTIONAL - SEE REVERSE) 076-64-3754-
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) J (COUNTY)
C. CHECK ONE 0 CITY 0 ,OWN 0 VILLAGE
~~CIFY Brewster
D. STREET ADDRESS 31 Allen Road
10509
~
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 051 58-2635
D. SOCIAL SECURITY NUMBER -
2. RESIDENCE A. ~ew York B. Dutchess
( TATE) (COUNTY)
C. CHECK ONE 0 CITY D~OWN 0 VILLAGE
AND W .
SPECIFY applnger
1548 Route 9 Aut. 6 B
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0.... NO
13. A. AGE 37 13.B. DATE OF BIRTH 09 / 04 /1965
MONTH DAY YEAR
12590
ZIP
D. STREET ADDRESS
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE 31 3B. DATE OF BIRTH
ZIP
DYES 0" NO
14. EMPLOYMENT
....
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4. EMPLOYMENT
A. USUAL OCCUPATION Truck Driver
B. TYPE OF INDUSTRY OR BUSINESS N Y S Thruway Aulhorilv
5. PLACE OF BIRTH 6eacol1..New York
(CITY, STATElCuuNTRY IF NOT USA)
6. FATHER
A. NAME Richard WiUiam Galente
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME J'.I~C~ ,'iIlIAnftA Wil~nn
B. COUNTRY OF BIRTH t J ~ A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
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
A. USUAL OCCUPATION Hairdresser
B. TYPE OF INDUSTRY OR BUSINESS Hair Palace II
15. PLACE OF BIRTH Manhattan. New York
(CITY, STATE/COUNTRY IF NOT USA)
18. FATHER
A. NAME James Patrick Donaghey
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Joan Patricia Devlin
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
q
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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MONTH O~ 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
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
o 0
o 0
o 0
o 0
declare that no lega impediment exists
21. SIGNATURE OF GROOM ~
22. SIGNATURE OF BRIDE ~
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23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York Sta bride and groom named above by any person authorized by New York Domestic
Relations Law !l11 to perform marriage ceremonies within ew York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o 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 25. B. ~~6~~~~~~f~~0
~
{ SEAL }
'-v-'
YEAR
YEAR
MONTH
DAY
NAME (PRINT)
SIGNATURE ~ -
MAILING ADD'3ESS
TIME
MONTH
TE 05119/200
r Falls NY 12590
N TA
27. TYPE OF CEREMONY
o ~L1GIOUS
03 9 0 OTHER, SPECIFY
09:1&1
PM
05
20
20 3 07
18 2003
IP
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE ANO AT THE TIME AND
PLACE INDICATED.
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~)o.i +"l e~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LLAGE OF
SP~CIFY Wt1/>{JJnrK Pet lis
10 CIVIL
/2
29. OFFICIANT
NAME (PRINT)
TITLE
SIGNATURE ~
MAILING AD{RES
. /'.
U v t^ 0,1
STREET
30. WITNESS TO
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
NAME (PRINT)
SIGNATURE ~