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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Ron'lM1l~arle BinQ!;Jfi SURNAME
CQuNTYDlltcre9C::
CITYfTOWN \^/appinger
~~J~~CRT 1368
~5~I~J~R186
1. A. FULL NAME
FIRST
8. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 152 74 0975
2. RESIDENCE A. Ne~A-rWrsey B. NlE~~
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Bloomfield
D. STREET ADDRESS 36 PrnSrE"~t Str~pt ZIP n7nn~
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES..t] NO
M~ /qtv / ~1
3. A. AGE21
4. EMPLOYMENT
3B. DATE OF BIRTH
A. USUAL OCCUPATION Military
B. TYPE OF INDUSTRY OR BUSINESS II S. Marine Corp
5. PLACE OF BIRTHEFJQI,~e~T~~TdifSey
6. FATHER
A. NAME Ronald Earle Banks
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Oa\'m Maric Bingharn
B. COUNTRY OF BIRTH U S ,A,
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF pREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
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(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
C. DATE LAST MARRIAGE ENDED?
MONTH 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
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
)',\~~'~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Elisl :::l N Bonini
lJi1i5rE CURRENT SURNAME
..J
11. A. FULL NAME
FIRST
8. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
c. SURNAME AFTER MARRIAGE ~ingham
(OPTIONAL. SEE REVERSEj
D. SOCIAL SECURITY NUMBER 120-66-4141
12. RESIDENCE ANeWTJ'J?rl.< B. 01 !!~~?s
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND n bk .
SPECIFYrOllg eepsle
D. STREET AODRESs4~~r<=l~kpnkill Rn<=lrl ZIP1 ?RO:i
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 00tJ NO
13. A. AGE20 13.B. DATE OF BIRTH M'hOrH /OlAY ~~
14. EMPLOYMENT
A. USUAL OCCUPATIONSales
B. TYPE OF INDUSTRY OR BUSINESS T radE" ~ecrpt~
15. PLACE OF BIRTHB~tiW~A~~TX 9!j& USA)
16. FATHER
A. NAMERichard Pasquale Bonini
B. COUNTRY OF BIRntl S p..
17. MOTHER
A. MAIDEN NAME Maryann Pacella
B. COUNTRY OF BIRTtU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
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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
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1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, t
as to my right to enter into the marri
21. SIGNATURE OF GROOM ~
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
knDwledge and belief that the information I provided is true
1
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ent exists
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 ~11 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 CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
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{ SEAL }
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STR ET
30. WITNESS TO CEREMONY
NAME (PRINT)~" ( \ \ e.... C. 0ef\.. 'r
SIGNATURE~ 0(" f\. \ ~ l \J.. c. \.1~
DOH-9B (11/98)
DATE 12/1n/?002
by New York Domestic
TIME
MONTH
YEAR
MONTH
YEAR
AM
PM
12
11
2002 02
08 2003
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY)) l-t../jl..l6~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~TOWN OF 0 VILLAGE OF
SPECIFY V )/1 f t'" U2( r