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COUNT'Qutchess
C'TYfT~wJl'lappinqer
~~J~~CR' 368'
~5~'~JW123
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christopher J. Oi Prim a
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
~. ~t . t' i~
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L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Marisa L. Girvalo
MIDDLE CURRENT SURNAME
~
1 A. FULL NAME
11. A FULL NAME
FIRST
FIRST
"-
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGEOi Prima
(OPTIONAL. SEE REVERS~ 16-66-0971
D. SOCIAL SECURITY NUMBER .,
12. RESIDENCE New York BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN 0{] VILLAGE
~~~cIFWappinqers Falls
D. STREET ADDRES3 0 Oelaverane Avenue Apt zlP12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? "'0 YES 0 NO
13. A. AGt21 13.8. DATE OF BIRTH 04 M 07 1381
MONTH DAY YEAR
B BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSb64-68-3943
D. SOCIAL SECURITY NUMBER
2 RESIDENCE tNew Y Ot"k B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN""O VILLAGE
~~~CIFY Wappinqers Falls
o STREET ADDRESS' 0 Delaverqne Avenue Apt ZIP 12590
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? "'0 YES 0 NO
As A976
DAY YEAR
3. A. AG25
09
MONTH
3B. DATE OF BIRTH
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8. TYPE OF INDUSTRY OR BUSINESJ..ltz Quality Foods
5 PLACE OF BIRT5roroc, New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAMESalvatore Di Prima
B. COUNTRY OF BIRTtU S A
7. MOTHER
A MAIDEN NAME nehorah Anginnn
B. COUNTRY OF BIRTHU S A
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATlor6ookkeepinq
B. TYPE OF INDUSTRY OR BUSINESWappingers Falls Toyota
15. PLACE OF BIRTPouohkeeosie. New York
(CI'!'ir. STATE/COuNTRY IF NOT USA)
16. FATHER
A. NAMMichael GilValo
B. COUNTRY OF BIR1Y S A
17. MOTHER
A. MAIDEN NAMEC~rnlyn Oi I nfp-tn
B. COUNTRY OF BIRM S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
YEAR
YEAR
MONTH DAY
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
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNUL ED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECR EE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 0 0 1ST
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 knowled~nd belief that the information 1
as to my right to enter into the marri e tate. :;J t;:;.., -
21. SIGNATURE OF GROOM ~ I ~ 22. SIGNATURE OF
AME
o 0
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o 0
o 0
lare that no legal impediment exists
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23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York St the bride and groom named above by any
Relations Law ~11 to perform marriage ceremonies within ew 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
{ } NAME (PRINT)Gloria J.
TIME YEAR
SEAL SIGNATURE DATdl8/07/2002
'-,-I !:~~ar~f:ush Rd Y ST1:590 ZIP 2:10 ~~
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
06 2002
by New York Domestic
MONTH
YEAR
2002 10
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNT~(-4-jp ~~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
RELIGIOUS
9 0 OTHER, SPECIFY
~CIVIL
29. OFFICIANT
NAME (PRINT)
-..--
J U.!{7IC e...
. .
SPECIFY
ZIP
31 WITNESS T~EREMONY ./."
""'I'''''' ~.c.e 6LL, 10 fie j _Ie
SIGNATURE~ ~~ ~JtiL~
5TATE~~151~L~ 55:
COUNTY OF J ~
Affidavit for
Correction of Marriage Record
FOR OFFICIAL NYS USE ONLY
, NEW Y~RK STATE DEPARTMENT OF HEALTH
Vital Records'Section
We, CrlL\~tCOY17J~\ [)\ PrirrC'-and
\j (Groom)
being severally sworn. depose and say that:
2,
Marriage License ]f bY,CitY(Town:
EX U/\"
Date of Marriage L , Lt'J.,
1,
We reside at:
3.
4.
Error(s) appearing on record (list exactly):
a. JOQfV~ D.().6 L\-~1
b.
c.
5.
Correct informa~ion as it should appear (list exactly):
a. ~/~1
b.
c,
6. Documentation Submitted: ,.
.
a.
13/Krl-l c:3t;--,eT/F/c/l-rF
p ~ J' V '=-~ !..s Lie G N ~ ~
b.
c.
Subscribed and sworn to oJ
(affirmed) before me this
. r\
Notary Public .
IF
day of ~ (}h c2oo~
/
DENlSE A. MORSE 4S812~2
Nata' I\tbllc. Stale of New York
Cc~1JJ;/) 2...
CGmmtaal&fl ExpIres 3/23 ~
notary public outside New York State
NOTE: Certificate of Authenticity required fo
(over)
DOH-1827 (9/98)
"- ----".~'-'--'~-~
NFW \JRK STATE j
- ~p- MiA I
- Ccr'''-""crerof\lclor'je',"ccs DRIVER LICENSE
10:418221 427<- ' ,. I
DOB:04-O~~1' "F.;",
GIRV ALO,MARIS~b:~:~,. ) ~_ (
10 DELAVr,GNEAV NOF ,. j,'r,
WAPPING is.t.tS. NYff. "J1."
12590 ! jlc~ - ',I ,1' "
SEX: F EYE~, B"~... iU3 <C~LA S: 0 ..i....t^J
END i!\ES1K'-""7:1' ;'-1
ISSUED O4-O!):Q2'.>EXP!BES: . -10 . r:
'\,-'--," -~--l. __''-':'__ ..- _ ---'7-7 _-"<-.>
Lf'lg\Rwib'II'\,j\' '81~~;,j
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~MillwmJJ~~QQQQ~~ill%UL~
fI New York State Department of Health I
~ Albany, N. Y. 12237 ~
~ C!Iertificate of !iirtq ~egistration ~
) p
~ This certifies that a certificate of birth has been filed under the name of; ;
MARISA LYNN GIRVALO
Sex:
Female
Born on:
Ap r il 7, 198 1
At:
City of Poughkeepsie
Name of father:
, New York
Michael W. Girvalo
Maiden name of mother:
Carolyn T. DiLoreto
Date filed:
April 23, 1981
Local Registration No.:
547
Date issued1' April 23,1981 ~ioTEJ--.;;I.~~
.JY..n Registrar of Vital Statistics :;)
~r Address: Municipal Bldg. Poughkeepsie, NY -
Th;, oolke ;, vo;d ;1 ;1 cool.;", eoy e"'"~' d' c....c,;o"'. 6\l1501] .
(ill ~
::::~ OF~~~~ SS
We. Cr1(\~taJtf,\ D\ Qri('('C'--and
(Groom)
being severally sworn. depose and say that:
1 . We reside at: ')
Affidavit for
Correction of Marriage Record
FOR OFFICIAL NYS USE ONLY
/)1 j.,''1 ['~C--/ --J /';/11
State File # '-/ 7 _jJ 7;' -;7<.)2/->'''''''1
Groom:~STO{JI-/1FU ,J) ,J!....l<lfnl1
Bride: {YJ MJ S II L. (;./ t \1 {:+L-tJ
Date Completed: ..s I do
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
2.
Marriage License ~.CitY/T.. own:
,,\, I.. \,....
Date of Marriage L L.r-:J,.
__'1
#/3(P<6
3.
4.
Error(s) appearing on record (list exactly):
y~ vI'li IJ. D ') Q
a. ~:=) .(/.1,_)
4\~J
b.
c.
5.
Correct information as it should appear (list exactly):
a. -W~J~J
b.
c.
6. Documentation Submitted:
,
r
./'
a.
8/,€-TH eeLTIF/~l'Ire
b.
~ f ..
') If I V t;-;(!..s ~ ; c E III 5 t!'
c.
() b r2oo~
day of xj~'p e::.,
DENISE A. MORSE 40012!;2
Notal" f\Jbllc. Stale of New York
Ccl'1JJJ/1 ~
CGmmlnfon ExpIres 3/23 ~
notary public outside New York State
Subscribed and sworn to
(affirmed) before me this
. ri
Notary Public' .
NOTE: Certificate of Authenticity required fo
(over)
w
(/)
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...J
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
z z PLACE INDICA TED
a: Q W
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CITYrTOW~appinqer
~~~~~CR' 368
~E~I~J~' 23
STATE OF NEW YORK I
DEPARTMENT OF HEALTH
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
AFFIDAVIT, LICENSE and tcORDECTED ~y AFFIDAVIT 131
CERTIFICATE OF I, 200204 3~91
MARRIAGE L WSUPPLEMENTAL FILES/L7/D3 f2cJIL
FROM THE BRIDE
Marisa L. Girvalo
MIDDLE CURRENT SURNAME
~
A FULL NAME
FROM THE GROOM
Christopher J. Oi Prima
MIDDLE CURRENT SURNAME
FIRST
11 A FULL NAME
FIRST
BIRTH NAME, iF DIFFERENT
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGEOi Prima
{OPTIONAL - SEE REVERSE,,\, 1 66-091
D SOCIAL SECURITY NUMBER I 6- 1
12 RESIDENCE New Yor!< BDutchess
C CHECK ONE (STATE) CITY [1 TOWN "'J VILLAGE (COUNTY I
~~~CIFWaDDinaers Falls
D STREET ADDRES~ 0 Delaverane Avenue A---RL- ZiP' 2590 _
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILL~GE' "'[] YES [J NO
n4~
MONTH DAY YEAR
C SURNAME AFTER MARRiAGE
(OPTIONAL SEE REVERS"'64 6n 3943
D SOCIAL SECURiTY NUMBER U - 0-
RESIDENCE tNew York B. Dutchess
(STATE) (COUNTY)
C CHECK ONE l..J CITY TOwN""IJ VILLAGE
~~~CIFY Wappinqers Falls
D STREET ADDREss1 0 DelaverQne Avenue Apt. ZIP 12590
is RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE' "'[] YES IJ NO
/18 /1976
DAY YEAR
AG~1
AG25
09
MONTH
14 EMPLOYMENT
A. USUAL OCCUPATlor5Qokkeepino.
B. TYPE OF INDUSTRY OR BUSINES~appingers Falls Toyota
15. PLACE OF BIRTlPOuohkeeDsie, New York
(C1T'f' 5T A TEiCOONTRY IF NOT USA)
16 FATHER
A. NAMMichael Girvalo
B COUNTRY OF BiAlY S A
13B DATE OF BIRTH
13 A
3B DATE OF BIRTH
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A USUAL OCCUPATlo~river
B TYPE OF INDUSTRY OR BUSINESJ...ltz Quality Foods
5 PLACE OF BIRTf3romc New York
(CITY, STATE/COUNTRY IF NOT USA)
6 FATHER
A NAMESalvatore Di Prima
B. COUNTRY OF BIRT~ S A
MOTHER
A. MAIDEN NAME Oeborah Angiono
B. COUNTRY OF BIRTHU S A
8 NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
17 MOTHER
A. MAIDEN NAMECamtyn Oi I orp.tn
B COUNTRY OF BIR1\J S A
18 NUMBER OF THIS MARRIAGE 1
19 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED IlY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
~-
B. HOW DID LAST MARRIAGE END' (3) U DIVORCE
C DATE LAST MARRIAGE ENDED?
(3) [1 ANNULMENT
/ /
(2) 0 DEATH
B HOW DID LAST MARRIAGE END' (3) [] DIVORCE
C DATE LAST MARRIAGE ENDED'
131 [] ANNULMENT
/ /
(2)
DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES [J 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
MONTH DAY YEAR
D ARE ANY FORMER SPOUSE{S) ALIVE? YES:::' NO
20 IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DA TE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT LISA) SELF SPOUSE
:;j
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lare that no legal impediment eXists
DATE 08/01/2002
by New York DomestiC
TIME
YEAR MONTH
YEAR
DAT~8/07 /2002
Y 12590
AM
2:10 PM
2002 '10
06 2002
ZIP
2B PLACE WHERE MAP,RIAGE OCCURRED
A. STATE NEW YORK, B couNnDf-,i1'j.e,9.
C LOCATION OF CEREMONY 13' I. V
(CHECK ONE AND SPECIFY) ft1 ()
--- CITY OF -'f' TOWN OF VILLAGE OF
SPECIFY W-1-fPt,r{(7 BR
RELIGIOUS
OTHER, SPECIFY
~CIVIL
TITLE
~
j iA.!{71 C e...
. .
WITNESS T?EREMONY .....:'
::::~::: ~~ ~oq&~JA
oL./36Q/ / ()~rrt
" ,.. -. - ..-- - -_._._-~-_.-------_._-- ;.\. . .~~
. I'-JFW \'ORK STATE ·
, ct;9p M-fA I
"cc~m'SS'Cce'QiMCIU'Jec":"s DRIVER LICENSE
,10.418221 427>.;>:'/1
DOB:0~7-81 '-"!,o.f'
GIRV ALO;W-RIS~i,,~. )~,
10 DELAV~GNEAV NOfc.fi'i'
~!~I:J~,\, I ~~t,,',;,~,.B:,; L:', ~'Di~',
END R"'Srf,~-.-,,""r, : 'iF 1
ISSUED ~~'3:'~X.~IB~...: ,~J~ ,",I,
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'Lj\.A"V 81~260>
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~~~~~~~~
fI New York State Department of Health 11
~ Albany, N. Y. 12237 ~
~ Clledifintie of 'liirtq ~egistrntion ~
~ F
~ This certifies that a certificate of birth has been filed under the name of: ~
~
~
MARISA LYNN GIRVALO
Sex:
Female
Born on:
April 7, 1981
At:
City of Poughkeepsie
, New York
I
~
Name of father:
Michael W. Girvalo
Maiden name of mother:
Carolyn T. DiLoreto
Date filed:
April 23, 1981
Date issued1
April 23, 1981
Local Registration No.:
547
0~ .-*<' U ./--I'e ~Z
O..n Registrar of Vital Statisti~
~r Address: Municipal Bldg. Poughkeepsie, NY
This notice is void if it contains any erasures or corrections.
'_^II' STATE OF NEW YORK
..., DEPARTMENT OF HEALTH
Corning Tower
The Governor Nelson A. Rockefeller Empire State Plaza
Albany, New York 12237
Antonia C. Novello, M.D" M,P,H" Dr.P,H,
Commissioner
Dennis P. Whalen
Executive Deputy Commissioner
May 19,2003
Gloria Morse, Clerk
20 Middlebush Rd.
Wappingers Falls, NY 12590
Groom: Christopher J. DePrima
Bride: Marisa L. Girvalo
Enclosed is a copy of the marriage referred to by the above file in your office.
Correction to the original has been made based on:
_XXX_ Affidavit
RECEIVED
Court Order
MAJ' 2 7 2003
Officiants Statement
TOWN CLERk
Signature on original marriage affidavit
Statement verified by Cityffown Clerk
Other: Supplemental
Please file this amended record along with the supporting documehtation.
Sincerely,
New York State Dept. of Health
Vital Records Section
Marriage Registration Unit
PO Box 2602
Albany, NY 12220-2602
Enclosure