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:] COUNTY
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STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
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1. A. FUll NAME
Anthnny MArCe-1Ii
MIDDLE CURRENT SURNAME
L 0 SUPPLEMENTAL FILE
~
ARST
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B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCiAl SECURITY NUMBER n1~_~,,-g~gR
2. RESIDENCEA._____ Vnrlr B. (~MW.,~~~
C. CHECK ONE 0 CITY 0 TOWN 0 KlAGE
~~ClFY Wappingp.f'K Fall!':
D. STREET ADDRESS 7n Frs:mldindalp a.U,",", ,~ ZIP 17SQn
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VIUAGE? 0 e 0 NO
3. A. AGE 4 (} 3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Laborer
B. TYPE OF INDUSTRY OR BUSI~ESS H:ti~V DeRa~tme~t
5. PLACE OF BIRTH (c~~IW'i&~ York .
6. FATHER
A. NAME Jo~eph Marrelli
B. COUNTRY OF BIRTH '-' , A
7. MOTHER
A. MAIDEN NAME .~AAa Kaiser
B. COUNTRY OF BIRTH Italy
8. NUMBER OF THIS MARRIAGE 2
FROM THE BRIDE
11. A. FUll NAME FIRST Q~~en M \Al!~ SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Barletta
c. s~~M~~~~e~~SE) aSarcelli
D. SOCIAL SECURITY NUMBER 120-64-3656
12. RESIDENCE A. _ York B. (g~e55
c. CHECK ONE 0 CITY 0 TOWN 0 v.ltLAGE ..'
~~CIFY \IV"'ppin9,",r~ FAII~
D. STREET ADDRESS ~o Franldindale A>.'-enue ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILlAGE? 0 4lI$ 0 NO
13. A. AGE 37 13.B. DATE OF BIRTH . MaJD / DD1 / ~5
14. EMPLOYMENT
A. USUAL OCCUPATION Oome~tic Engineer
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH (C~~*yr Jeuey
16. FATHER
A. NAME
Aldo Ruta
USA
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME Phyllis Baflelta
B. COUNTRY OF BIRTH U g A
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1
DEATH
Q
1 0 0
B. HOW DID LAST MARRIAGE END? (3) 0 DHtlRCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? MONTH O( DAy27/ vJ.W91
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 yiil!; 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
g
B. HOW DID LAST MARRIAGE END? (3) 0 IJIfoRce (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? U( 19/ ?OOO
MOHTli DAY ~
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 wt> 0 NO
1 D. 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
.J
01!Z7f2001 CesheA, New Yefk
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10/1912000 Peyghkeep6ie. New Yem
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK. DATE
This license authorizes the marriage in New York S groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies withi New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used onl urpose of a second or subsequent ceremon .
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
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{ SEAL }
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NAME (PRINT)
SIGNATURE.
MAILING ADORE
SIGNATURE.
OOH-98 (11198)
TIME
MONTH
YEAR
MONTH
YEAR
11:5%
01
20 3 04
01 2003
02
1)tl CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~SS
LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~VILLAGE OF
SPECIFY I8-I/Nt:=8ec::.K