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:s I A I t: Uf- NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Arcoli Abbatiello
COUNTYDutchess
CITYITO~tiWapplnger
D1STRICr) ~68
NUMBER
REGISTER149
NUMBER
1. A. FUll NAME
MIDDLE
CURRENT SURNAME
FIRST
..
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAl. SEE REVERSE121 16-1385
D. SOCIAL SECURITY NUMBER -
2. RESIDENCE A. New York B. Dutchess
(STATE) v!. (COUNTY)
C. CHECK Ottli.. [J CITY 0 TOWN 0 VILLAGE .
~~CIFY wappinger
D. STREET ADDRESS 11 ueer t<un t<oaa
ZIP 1 jl~~U
.",.
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 NO
03 /19 /1924
DAY YEAR
3. A. AGE 78
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Retired
5. :~::~~:I:~~:~~~~~~I~~ York
(CITY, STATEICOUNTRY IF NOT USA)
6. FATHER
A. NAME Dominick Abbatiello
B. COUNTRY OF BIRTH Italy
7. MOTHER
A. MAIDEN NAME Maria Rongo
B. COUNTRY OF BIRTH Italy
8. NUMBER OF THIS MARRIAGE 'Z.
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV&RCE CIVIL A'BULMENT
DE,fTH
a:
W
m
2
=>
Z
o
~
Iii
~
."
B. HOW DID LAST MARRIAGE ENO? (3) 0 DIVORf\ (3) CU1NULMENT 9~~ DEATH
C. DATE LAST MARRIAGE ENDED? / / 1
. MONTH .,.DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVOACED 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
w
en
z
w
o
::::i
i::li I A I t:. ~ILI:. NUMtft:H
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Iris R. Cantore
~
11. A. FUll NAME
FIRST
MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF OIFFERENT
C. SURNAME AFTER MARRIAGE Cantore - Abbatiello
(OPTIONAL. SEE REVERSE)105-18-6145
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA.New York B. Dutchess
(STATE) ~ (COUNTY)
C. CHECK ctNi'. CJ CITY 0 TOWN 0 VILLAGE
~~~CIFY wappinger
D. STREET ADDRESS 11 Deer Run Rosa ZIP '12590
VI'
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILlAGE? 0 YES 0 NO
13. A. AGE 79 13.B. DATE OF BIRTH 04 ,;08 }923
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Retired
B. TYPE OF IND\J.SIRY OR QVSINE~.
15. PLACE OF BIRTHMannauan, New York
(CITY, STATElCOUNTRY IF NOT USA)
16. FATHER
A. NAME Vincent Cantore
B. COUNTRY OF BIRnltaly
17. MOTHER
A. MAIDEN NAME Adele Perugini
B. COUNTRY OF BIR,...,taly
lB. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIOORCE CIVIL A"WULMENT
D~TH
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
provided IS true a that declare that no lega impe Iment exists
. SIGNATURE OF BRIDE ~ 12 · ~ .h1~ .I
~SE CURRENT NAME
09/1812002
DATE
authorized by New York Domestic
ose of a second or subsequent ceremony.
25. A. SOLEMNIZATION PERIOD BEGINS
TIME MONTH
YEAR
DATE 09/18/2002
er falls, NY 12590
A ZI
29. OFFICIANT
NAME (PRINT)
03:04 ~~ 09
~VIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY 'J)llith~.f
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILJ..AGE OF
SPECIFY ~fw,e""
NAME (PRINT)
SIGNATURE ~