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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christopher Batis
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinqer
~~~:~c~ 1368
~5~I~J~R 130
1 . A. FULL NAME
FIRST
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N
B. BIRTH NAME, IF DIFFERENT
I
:JJ(,
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 050 58-1992
D. SOCIAL SECURITY NUMBER -
2. RESIDENCE A. N Y B Dutchess
c. CHECK ONE (ST~) CITY 11 TOWN 0 VILLAGE (COUNTY)
~~~CIFY Wappinger
D. STREET ADDRESS 45 C Middlebush Road ZIP 12590
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES t5' NO
11 /04 / 197
DAY
3. A. AGE 29
38. DATE OF BIRTH
{1, ii' ;J /1
7! "V'i
MONTH
YEAR
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
April A. Squillante
MIDDLE CURRENT SURNAME
~
4. EMPLOYMENT
A. USUAL OCCUPATION H V A C Tech
B. TYPE OF INDUSTRY OR BUSINESS Landmark Air Systems
5 PLACE OF BIRTH New Milford, Connecticut
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Joseph P. Batis
8. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Eileen Cassidy
B. 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
11 A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Squillante-E1atis
(OPTIONAL - SEE REVERSE) 071-66-5731
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. N Y B. Dutchess
(STATE).J (COUNTY)
C. CHECK ONE 0 CITY LJ TOWN 0 VILLAGE
D. :~:~~7A::~g~n~e~lddlebush Road ZIP 12090
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ['j NO
04 /22 /1978
DAY
13. A. AGE 24
13.B. DATE OF BIRTH
8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
MONTH
YEAR
(2) 0 DEATH
14. EMPLOYMENT
A. USUAL OCCUPATION Administrative Coordinator
B. TYPE OF INDUSTRY OR BUSINESS Search For Change
15. PLACE OF BIRTH Cortlandt, New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Fred Squillante
8. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Susan Bleakley
8. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DE6TH
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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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22. SIGNATURE OF BRIDE ~
23. SUBSCRIBED AND SWORN TO BEFORE ME NAME 08/14/2002
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
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 CI~ICLERK J M 25. A. SOLEMNIZATION PERIOD BEGINS-
} NAME (PRINT) (,;.i on . orse
{SEAL SIGNATURE ~ DATE 08/14/2002
'-v-I M'1a~ffij~bush R ails, NY 12590
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
o
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o
o
o
o
o
o
o
YEAR
STATE ZIP
27. TYPE OF CEREMONY ,.-
RELIGIOUS 1 ~IL
OTHER, SPECIFY
W
I- 29. OFFICIANT
<( NAME (PRINT)
U
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NAME (PRINT]
SIGNATURE ~ .
DOH.98 (11/98)
,'i\Z)
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~
C. LOCATION OF CEREMONY
(CHECK ONE AND 9PECIFY)
o CITY OF cY'f;WN OF 0 VILLAGE OF
SPECIFY ~~h~iL..1.,
31.
NAME (PRINT)
SIGNATURE ~
-