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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
John P. Weyant
MIDDLE CURRENT SURNAME
23. SUBSCRIBED AND SWORN T
SIGNATURE OF TOWN 0 I CLERK ~
This license authoriz S he marriage in New Yo 01 the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies wlthi New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o II checked, this license is to be used only lor the purpose 01 a second or subsequent ceremony.
,-^-., 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) Glori J Mo!se
.., TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ -- uA1E07/09/2002
"-v..I ~~t.f.cfdi~ljush Rd r Falls NY 12590 1:54 ~~ 07
STREET STATE ZIP
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
COUNT,Qutchess
CITYfTOWNWappinqer
~~~~~CR" 368
~E~'~J~F98
A FULL NAME
FIRST
8 BIRTH NAME, IF DIFFERENT
3 A. AG142
10
MONTH
3B. DATE OF BIRTH
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4. EMPLOYMENT
A USUAL OCCUPATION Custodian
B. TYPE OF INDUSTRY OR BUSINESSWapDingers Central School
5 PLACE OF BIRTt5eaCOne>L New -Vori .
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME John Weyant
B. COUNTRY OF BIRTHU S A
7. MOTHER
A. MAIDEN NAME Alice Hunt
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
oL
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C DATE LAST MARRIAGE ENDED? 08 /2-1 /'1995
MONll1l DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? TI YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
18T08/21/1995 Poughkeepsie, New Yot1( 'tJ
2ND
3RD
4TH
I, being duly sworn, depose an
as to my right tD enter into the
DEATH
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STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
.atllt
" /I
'o~1.3 '(,10
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Laura Acosta
~
11. A. FULL NAME
CURRENT SURNAME
FIRST MIDDLE
8. BIRTH NAME (MAIDEN NAME), IF DIFFEREN~iuliano
C. SURNAME AFTER MARRIAGE Weyant
(OPTIONAL. SEE REVERSEh52 50-6438
o SOCIAL SECURITY NUMBER U -
12 RESIDENCE ,New Yot1( sDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY '6 TOWN 0 VILLAGE
~~~cl~appinqer
D STREET ADDRESst4 Winesap Lane
ZIP12590
o YES"tJ NO
ui57
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13, A. AG~5 13.B. DATE OF BIRTH 04 ,.aO
MONTH DAY
14. EMPLOYMENT
A USUAL OCCUPATIOtJ3US Driver
B. TYPE OF INDUSTRY OR BUSINESSWapp;ngers Central School
15. PLACE OF BIRT~Ort Chester;New Vork
(CITY, STATE/COUNTRY IF NOT USA)
16, FATHER
A. NAMNincent Giuliano
B. COUNTRY OF BIRTU S A
17. MOTHER
A. MAIDEN NAMEAntoinette Trofibio
B. COUNTRY OF BIRTlI S A
18, NUMBER OF THIS MARRIAGE 3
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
2 0
B. HOW DID LAST MARRIAGE END? (3)"6 DIVORCE (31 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 03 / '14 /2002
MONDt DAY YEAR .
D. ARE ANY FORMER SPOUSE(S) ALIVE? TI 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
18T05/16/1980 White Plains, New Yot1( fJ
2ND03/14/2002 PouahkeeDsie. New York '6
DEATH
o
. SIGNATURE OF BRIDE
3RD
4TH
. I that the information I provided is true an
o
DATE 07/09/2002
YEAR
10
2002 09
07 2002
o 0 RELIGIOUS
<::) d 9 0 OTHER. SPECIFY
1)q: CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY 01 ;trAp~5'
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
29 OFFICIANT
NAME (PRINT)
o CITY OF 0 TOWN OF jtJ.. VILLAGE OF
SPECIFY ';; Sh n; il