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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Mark J. Loncto
MIDDlE CURRENT SURNAME
COUNTY Dutchess
CITYITOWN Wl:.H>pinqer
~~J:k9[ 1368
~5~~J~R 29
1. A. FW NAME
FIRST
Q.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAl - SEE REVERSE) 126-40-7347
D. SOCIAL SECURITY NUMBER
2. RESIDENCEA. Ne~YOrk B. Dutchess
(S A (COUNTY)
C. CHECK ONE CtrY 0 TOWN 0 VIUAGE
~~CIFY Beacon.'
D. STREET ADDRESS 46 Schenck Avenue ZIP 12508
E. IS RESIDENCE WITHIN UMITS OF CITY DR INCORPORATED VlUAGE? dyES 0 NO
3. A.AGE :\7 3B. DATE OF BIRTH 11 / 14 / 1965
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAl OCCUPATION ar enter
B. TYPE OF INDUSTRY OR BUSINESS Self - Employed
5. PLACE OF BIRTH Pouanlrp.p.n~;~,1"ew York
(CITY,~IFNUI USA)
6. FATHER
A. NAME Raymond Lonclo
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Edna llh'lp. .In~kp.r~
B. COUNTRY OF BIRTH l J S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
(2) 0 DEATH
B. HOW DID lAST MARRIAGE END? (3) 0 DIVORCE
C. DATE lAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
YEAR
MONTH DAY
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, STATEICOUNTRY,IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Maryann E. Bolander
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Maitracion
c. SURNAME AFTER MARRIAGE Loncto
(OPTIONAL - SEE REVERSE) 096-44-2215
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STA!flI (COUNTY)
C. CHECK ONE IT CITY 0 TOWN D VILLAGE
~~CIFY Beacon
D. STREET ADDRESS 4~ Schenck Avenue ZIP 12508
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? d' YES 0 NO
13. A. AGE 48 13.B. DATE OF BIRTH 06 / 15 /1954
MONTH DAY YEAR
11. A. FULL NAME
14. EMPLOYMENT
Seer
B. TYPE OF INDUSmy OR BUSINESS Village Of Wappinqers
15. PLACE OF BIRTH Newburah. New York
(CITY, STATElCOUNTRY IF NOT USA)
16. FATHER
A. NAME Philip Mattraeion
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Hp.le" Seel~
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES .
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID lAST MARRIAGE END? (3) D '"D'IVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 09/ 01 / 1994
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? D~ES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CTTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
nQtn 1/1994 Poughkeepsie. New York: 0 .,
D
o
o
pedi
DEATH
o
D D 1ST
o D 2ND
D D 3RD
o D 4TH
nowledge and belie that the infDrmatlon
23. SUBSCRIBED AND SWORN TO BEFORE ME 03/27/2003
SIGNATURE OF TOWN OR CITY ClERK ~ DATE
This license authorizes the marriage in New York 8ta named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within w York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o "checked, this license is to be used onl for the purpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
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{ SEAL }
'-v-I
NAME (PRINT)
R
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
TIME
MONTH
YEAR
09:27-M
PM
03
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
l~VIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY tJtITCi.-eSJ
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF D TOWN OF ~LAGE OF
SPECIFY ~APIJ~~( FA/-I,,$
tJ,Lc. AfA :rLi~T1C.e
1/b~~
jtJ.y
STATE
26. SOLEMNIZATION OCCURRED
TI MO. DAY Y R
~~ - ro -0.3
~,':= C!I/JIL; S /I :'!1!D0J4 L ~ ""-'
SIGNATURE~ ~ ';.~pW DATE
MAILING ADDRESS ,1\
21 H'CAffelr'/ PI.. VJAPYI#lJ~'S -FA-l.t.>
STREET CITYITOWN
30. WITNESS TO CEREMONY ./J
NAME (PRINT) t9..!/2 /. io~~
SIGNATURE~ r~ PtJ5L
DOH.Be (11/98)
/J. 5 90
ZIP
31. WITNESS TC} CjREMONY
NAME (PRINT) IV AN c-,t A-N /II ~
SIGNATURE~ ~