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DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
~~n Giaco CURRENT SURNAME
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I, being duly sworn, depose and say, that to the best of my knowledge and be ief that the information I provided is true
as to my right to enter into the marriage state,
21. SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~
"
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York. S te of the bride and groom named above by any person authorized
Relations Law ~11 to perfonn 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 urpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
COUNTYDutchess
clTYrrowN\Mappinger
2~J:~c:1368
~5~~J~R1 62
1. A. FULL NAME
FIRST
Cl.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE!..
D. SOCiAl SECURllY NUMBER u65 58 4750
2. RESIDENCEA.N YsTATE) B. D~S5
C. CHECK ONE 0 CITY o,l] TOWN 0 VILLAGE
~~CIFY \^lappinger
D. STREET ADDRESS6 Baldwin Drive ZIP 1 ?!=iQO
E. IS RESIDENCE WITHIN UMITS OF CITY OR tlCORPORATED VUAGE? 0 YEs...o NO
Jlk /~ / ~il1
3. A. AGE31
4. EMPLOYMENT
3B. DATE OF BIRTH
A. USUAL OCCUPATION Telephone Techniciiiln
B. TYPE OF INDUSTRY OR BUSINESS \j~r~on
5. PLACE OF BIRTHP-I~MW~J'~
6. FATHER
A. NAME John Giaco
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Carolann Michelini
B. COUNTRY OF BIRTH lJ S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
(2) 0 DEATH
o .
o
B. HOW DID lAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
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. STATEICOUNTRY. IF NOT USA) SELF SPOUSE
t-"-.
{ SEAL }
'-v-I
,;j;CE;; S;~;;ONC"
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Carrie L Pprr;n
MIDDLE CURRENT SURNAME
~
1,. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Per-r-'I" - G',aco
(OPTIONAL - SEE REVERSE\,:; I I
D. SOCIAL SECURllY NUMBER u64-68-0996
12. RESIDENCE AN -V;STATE) B. D149-~wr!::
c. CHECK ONE 0 CITY i!'l TOWN 0 VILLAGE
AND _-'AI '
SPEClnv, :::Irr'ngE'r
D. STREET ADDRES..n AfllrJwin Drive zIP12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES -6 NO
13. A. AGE29 13.B. DATE OF BIRTH ~H /1~AY -1'~
14. EMPLOYMENT
A. USUAL OCCUPATIONPhlebotomist
B. TYPE OF INDUSTRY OR BUSINESSSt ~r:::lnf':i!:: I-ln!=:rit;::!1
15. PLACE OF BIRTHY~GI~'F'toqrJfA)
16. FATHER
A. NAMERobert Perrin
B. COUNTRY OF BIRTH J ~ A
17. MOTHER
A. MAIDEN NAMEP-atricia Connell
B. COUNTRY OF BIRn! I S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o
o
DEATH
o
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
o 0
o 0
o 0
o 0
n legal iplpediment exists
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
TIME
MONTH
DAY
YEAR
MONTH
YEAR
DAY
AM
PM 11
28
2002 01
26 2003
S
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
TAT
27. TYPE OF CEREMONY
o ~ RELIGIOUS
9 0 OTHER, SPECIFY
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEWYORK B. COUNTy'bvrz:.t+ESS
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY rISUnL~
TITLE l' A s "TO ~
DATE \7- / z. <6' / 6?.
I I
'--
NAME (PRINT)
SIGNATURE ~
DOH-sa (11/98)
NAME (PRINT)
SIGNATURE ~