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COUNT,Outchess
CITYfTOWN WappinQer
~~~~~c~1368
~G~'~~~R1 05
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Salvatore Daniele
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
~tlJ t
Cf~iJ-('a
L 0 SUPPLEMENTAL FILE
~
1. A. FULL NAME
FROM THE BRIDE
Patricia E. Curtin
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENrGerardi
C. SURNAME AFTER MARRIAGE Curtin
(OPTIONAL. SEE REVERSElo 10-32 8267
D. SOCIAL SECURITY NUMBER I -
12 RESIDENCE..New York BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFWappinger
D STREET ADDRESSP. o. Box 1832
11. A. FULL NAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSIill97 28-7386
D SOCIAL SECURITY NUMBER U -
2 RESIDENCE ANew York B. Westchester
(S~TE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN 0 VILLAGE
~~~CIFY New Rochelle
D. STREET ADDREss7 Cliff Street ZIP 10801
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? "'IJ YES 0 NO
A!i A 9:\!i
DAY YEAR
ZIP12590
o YES"tJ NO
1441
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGF61 13.8. DATE OF BIRTH n:\ ..11
MONTH DAY
3. A. AGRJ1
0:\
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATIO~ollection Representative
8. TYPE OF INDUSTRY OR BUSINESsVassar Brothers f\.~edical
15. PLACE OF BIRT~ew Rocheffe- New York
(CITY, STATE/COUNTRY'IF NOT USA)
38. DATE OF BIRTH
4. EMPLOYMENT
A USUAL OCCUPATION Retired
B TYPE OF INDUSTRY OR BUSINESS
5 PLACE OF BIRT~ew Rochelle, New York
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Bruno Daniele
B. COUNTRY OF BIRTHltaly
7. MOTHER
A. MAIDEN NAME Filnmf!ns nf! Ms!'.:i
8. COUNTRY OF BIRTH Italy
8. NUMBER OF THIS MARRIAGE2
16. FATHER
A. NAMtJoseph Gerardi
8. COUNTRY OF BIRTIJ S A
17. MOTHER
A. MAIDEN NAMECecilia Carson
B. COUNTRY OF BIRTLJ S A
18. NUMBER OF THIS MARRIAGE 2
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19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DEATH DIVORCE CIVIL ANNULMENT
1 1 0
8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2i6 DEATH B. HOW DID LAST MARRIAGE END? (3)'6 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C DATE LAST MARRIAGE ENDED? 0'1 /24 /2000 c. DATE LAST MARRIAGE ENDED? 05 /30 /1995
MONTH DAY YEAR MON!!i DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES ""0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? LJ YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM OA TE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 0 0 1STO!i/30/199!i Pnughkf!epsiel Nf!W York ~ 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is mpediment exists
as to my right to enter into the marriage state.
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
21 SIGNATURE OF GROOM '
23. ~~JfT~~~DO~NT~~~O~~ 6~g~~~~E DATE 07/16/2002
This license authorizes the marriage in New York State of t bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriaqe ceremonies within New Y State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
WOlf checked, this license is to be used only for the purpose of a second or subsequent ceremony.
(/)
Z - ~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
W { } NAME (PRINT) Glori
U TIME MONTH YEAR MONTH
:J SEAL SIGNATURE~
'-- .-J ~.ll.Itj.c:.I[\QD e~sush Rd 0:46 AM
-v- S~~E~ a iD liP PM 7 17 2002 9 14 2002
I CERTIFY THAT I SOLEMNIZED 28. PLACE WHERE MARRIAGE OCCURRED
THE MARRIAGE OF THE PER- ~
SONS NAMED ABOVE ON THE 1 0 CIVIL NEW YORK
DATE AND AT THE TIME ANO A. STATE B. COUNTY ~ .
PLACE INDICATEO 0 C. LOCATION OF CEREMONY
~~~t~~9i~~T f R. /~ I( fI ,A;; L J, j)., L i (S.4 tV J n (,~'TLE (-o..:q ~ i~:~ (CHECK ONE AND SPECIFY)
X ' a !SICITY OF.51 TOWN OF, 0 VILLAGE OF
SIGNATURE~/1~~...u1.I.n ~~ DATE ~A.q/ I, (;IO. t'~. 4'~ ~ Yc..v(':t.
MAILING ADD/Y7 C C~..f,Cz: C,-<- /<./l~.J" V I of 6./ SPECIFY j - . /i /~O.N I ~ ~ <J (.
STREET CITYiTOWN ~ .I . ZIP
30. WITNESS TO CEREMONY 31. WITNESS TO CE.!3.f!l10NY L.
NAME (PRINT) E~ NAME (PRINT) ...JD:>E.?,L/ c:;
Z; ~
YEAR
SIGNATURE ~.
DOH.98 (11/98)
SIGNATURE ~