159
:]
o
0\
LJ'1
N
~~
<:
~Iii
l-l
o
>-<
~
Qj
\<Z I-
lli :>
w <(
~~ C
...Jr-;LLJ-
is t1l ~ U.
I~--'U.
~ ~<(
o tI) Z
;:: l-l;:
~ Qj ~
~ t:
13 r:: <)
~..-l
w
"
~ t1l
~:3
<:
:;
u.
o
W
I--
<:
<)
u::
;::
a:
w
<)
w
a:
w
I
;:
(/)
(/)
w
a:
o
o
<:
>-
u.
(3
W
0-
(/)
z z
!5 B W
~ ~ l-
I-- Z <(
;g ~ ()
~ @ u:
~ u. i=
~ 0 a:
~ ~ W
W 0 ()
I- '"
o
z ~
COUNTY Dutchess
CITYITOWN Wappinger
DISTRICT1368
NUMBER
REGISTER 159
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
JoseDh F Gilleo
MIDDL~ CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
uti, if) ..1., ~~
L D SUPPLEMENTAL FILE
-1
1. A. FULL NAME
FROM THE BRIDE
Maria A. Pappalardo
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Lockwood
C. SURNAME AFTER MARRIAGE Gilleo
(OPTIONAL - SEE REVERSE)111_S3-6001
D. SDCIAL SECURITY NUMBER
12 RESIDENCE ANew York B. Dutchess
(STATE) >If (COUNTY)
C. CHECK ONE 0. CITY [J TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D STREET ADDRESs57 sutton Park Road
11. A. FULL NAME
FIRST
0-
N
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE\1 05-~6-8940
D SOCIAL SECURITY NUMBER '1 ~
2. RESIDENCE A. New York B. Dutchess
(STATE) oL (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN U VILLAGE
~~~CIFY WaPHingerS
D. STREET ADDRESS Fulton street
1'Jl;;n3
ZIP L'-'U
~
YES 0 NO
~68
YEAR
3 A. AGE33
ZIP '12590'"
....
YES 0 NO
/1969
YEAR
MONTH
DAY
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
06 /03
DAY
10
13. A. AGE33
13.8. DATE OF BIRTH
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Nail Technician
B. TYPE OF INDUSTRY OR BUSINESS Roseanns's
15. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE/COUNTRY IF NOT USA)
4. EMPLOYMENT
A. USUAL OCCUPATION Carpenter
8. TYPE OF INDUSTRY OR BUSINESS Self - Employed
5. PLACE OF BIRTHPeekskill, New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME James Lockwood
B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Priscilla Fell
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIOORCE CIVIL ANnULMENT
DEATH
o
6. FATHER
A. NAME Joseph Travis
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Alice Gilleo
8. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0. DIVORCE
(3) 0 ANNULMENT
/ /
(2) D DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(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
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
o
o
o
21. SIGNATURE OF GROOM ~
23.
2. SIGNATURE OF BRIDE
18T 0 0 18T
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I. being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I de
as to my right to enter into the m . ge state. -
W
en
z
W
()
::J
29 2002
DATE 09/30/2002
the bride and groom named above by any person authorized by New York Domestic
TIME
MONTH
YEAR MONTH
YEAR
ATE 09/30/2002
ppi er Falls, NY 12590
CITYITOWN STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
AM
03:59 PM
'10
01
200 1-1
ZIP
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY l>.I1t't/€~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF A TOWN OF 0 VILLAGE OF
SPECIFY it/;;PfJ/~
l~IVIL
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/98)
NAME (PRINT)
SIGNATURE ~