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086 Ziz ~~2 w ~~~ t- >-ffiz <( cgdal () ~~8 u: z- ~~6 ~ fEoU) a: 0>->- W Ujjj!3 () b~~ Z~~ COUNTY Dutchess CITyn-OWN WappinQer ~~~~~CRT 1368 ~5~'~J~R 86 STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM Gre~ory J. Giarrusso M OLE CURRENT SURNAME I I STATE FILE NUMBER (THIS SPACE FOR STA TE USE ONL Y) tl.t/7t .-1 11 'J /} /'l'tlf L D SUPPLEMENTAL FILE FROM THE BRIDE Carol A Rinne MIDDLE CURRENT SURNAME ~ A FUll NAME 11 A. FUll NAME FIRST FIRST 0- N BIRTH NAME (MAIDEN NAME), IF DIFFERENT Rrown C SURNAME AFTER MARRIAGE Giarrusso (OPTIONAL - SEE REVERSE) D SOCIAL SECURITY NUMBER 102-52-8643 12 RESIDENCE A. N Y B. Dutchess (STATE) (COUNTY) C CHECK ONE D CITY [JITOWN D VILLAGE AND W - SPECIFY applnger o STREET ADDRESS 30 Widmer Road ZIP 12590 E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VillAGE? DYES ['( NO 13.A. AGE 44 13BDATEOFBIRTH 1) /1:=i /1~67 MONTH DAY YEAR B BIRTH NAME, IF DIFFERENT C SURNAME AFTER MARRIAGE (OPTIONAL - SEE REVERSE) 122 38 8359 D SOCIAL SECURITY NUMBER -- 2 RESIDENCE A. N Y B. Dutchess (ST A TEl ICOUNTY) C CHECK ONE D CITY ~ TOWN D VILLAGE AND W . SPECIFY applnger D STREET ADDRESS 30 Widmer Road E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VillAGE? 3 A. AGE 54 3B. DATE OF BIRTH O~ / MONTH ZIP 12590 DYES i"'l' NO )4 / 194 DAY YEAR 4. EMPLOYMENT A. USUAL OCCUPATION Retired 14. EMPLOYMENT A. USUAL OCCUPATION Bus Driver B TYPE OF INDUSTRY OR BUSINESS Arlington Cntrl. Shools 15. PLACE OF BIRTH Pouahkeepsie. New York (CITY, ilfATE,COUNTRY IF NOT USA) 16. FATHER A. NAME Edward Brown B COUNTRY OF BIRTH USA 17 MOTHER A. MAIDEN NAME Greta Beneway B COUNTRY OF BIRTH USA lB. NUMBER OF THIS MARRIAGE 2 19. PREVIOUS MARRIAGES .... :> <( c lOU: :5u. 5<( z '" ;2 B. TYPE OF INDUSTRY OR BUSINESS 5 PLACE OF BIRTH Pouahkeepsie, New York ICITY, STATE/COUNTRY IF NOT USA) 6. FATHER A. NAME Greaorv J. Giarrusso B. COUNTRY OF BIRTH Italv 7. MOTHER A MAIDEN NAME Antoinette Paterno B. COUNTRY OF BIRTH Italv B NUMBER OF THIS MARRIAGE 2 9 PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT 1 0 B HOW DID lAST MARRIAGE END? (3) d'DIVORCE (3) D ANNULMENT C DATE LAST MARRIAGE ENDED? 08 / 07 / MONTHj DAY D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES D NO (2) D DEATH 1989 YEAR A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT 1 0 B HOW DID LAST MARRIAGE END? (3) dDlVORCE (3) D ANNULMENT (2) D DEATH C DATE LAST MARRIAGE ENDED? 10 / 28 / 1992 MONTf:l.; DAY YEAR D ARE ANY FORMER SPOUSE(S) ALIVE? U YES D NO DEATH o DEATH o a: w CD " OJ Z o z " >- :;: a: >- if> 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 1ST 08/07/1989 Poughkeepsie, New York 2ND 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 10/28/1992 Hillsborouah, New . . . . Hampshire D d 1ST D D 2ND D D 3RD D D 4TH my knowledge and belief that the information I provided is true d'" D D D D D D D gal impediment exists ...... 3RD 4TH I, being duly sworn, depose and as to my right to enter into the m 21. SIGNATURE OF GROOM ~ ~ DATE 06/25/2002 by New York Domestic w (J) Z W () ...J 23 SUBSCRIBED AND SWORN TO BEFORE M SIGNATURE OF TOWN OR CITY CLERK ~ This license authorizes the marriage n New York State of t bride and groom named above by any person authorized Relations Law 911 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY. D If checked, this license is to be used Only for the purpose of a second or subsequent ceremony. ~ 24. TOWN OR CITY CLE~K 25. A. SOLEMNIZATION PERIOD BEGINS { } NAME (PRINT) Glor . (,ors TIME MONTH YEAR SEAL SIGNATURE ~ .L-J ' '-v-I M"2~G~~dr~bush Rd a 02:40~~ 06 26 200 STREET ZIP I CERTIFY THAT I SOLEMNIZED THE MARRIAGE OF THE PER- SONS NAMED ABOVE ON THE DATE AND AT THE TIME AND PLACE INDICA T 08 24 2002 25 B. SOLEMNIZATION PERIOD ENDS AT MIDNIGHT ON MONTH DAY YEAR 1~'L 2B. PLACE WHERE MARRIAGE OCCURRED A STATE NEW YORK B. COUNTy;j)U-re~ C LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) D CITY OF D TOWN OF ~GE OF SPECIFY ~~ L6tn.& ~ 31. SIGNATURE ~ '