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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Giuseppe Russo
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
~IT~~~CRT 1368
~~~'iJ~R 80
1. A. FULL NAME
FIRST
a.
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 1 00-66-7000
o SOCIAL SECURITY NUMBER
2 RESIDENCE A. New York B. Ulster
(STATE) J (COUNTY)
C. CHECK ONE D CITY D TOWN D VILLAGE
~~~CIFY Marlboro
D. STREET ADDRESS 231 Highland Avenue
ZIP 12542
YES ~ NO
/ 197
YEAR
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? D
07 / 25
3 A. AGE 29
38. DATE OF BIRTH
MONTH
DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Restaurant Manager
B TYPE OF INDUSTRY OR BUSINESS Youngest Brothers
5. PLACE OF BIRTH Brooklyn, NeW York .
(CITY, STATElCOUNTRY IF NOT USA)
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6. FATHER
A. NAME Mario Russo
8. COUNTRY OF BIRTH Italy
7. MOTHER
A. MAIDEN NAME Frances Triolo
8. COUNTRY OF BIRTH Italy
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
8. HOW DID LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) D ANNULMENT
/ /
(2) D DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Amy M. T enneriello
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Russo
(OPTIONAL. SEE REVERSE) 101-68-7532
D. SOCIAL SECURITY NUMBER
12 RESIDENCE A New York B Dutchess
(STATE)...J (COUNTY)
C. CHECK ONE D CITY U TOWN D VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 20 Balfour Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES r!1 NO
06 /11 /~975
13. A. AGE 27
13.B. DATE OF BIRTH
MONTH
DAY
YEAR
14, EMPLOYMENT
A. USUAL OCCUPATION Reservationist
8. TYPE OF INDUSTRY OR BUSINESS Culinary Institute Of
15 PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Nicholas Tenneriello
8. COUNTRY OF BIRTH U S A
17. MOTHER
A. MAIDEN NAME Rosemarie PostiQlione
8. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE
(3) D ANNULMENT
/ /
(2) D DEATH
C. DATE LAST MARRIAGE ENDED?
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
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1ST D D 1ST
2ND D D 2ND
3RD D D 3RD
~ D D ~
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is tru
as to my right to enter into the marriage state,
D D
D D
D D
D D
no legal impediment
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State f the bride and groom named above by any person authorized
Relations Law 911 ~tJ1llrriagec~~m,,):~e..TH~.I,gg,~.~E VALID IN NEW YORK STATE ONLY.
If checked, this license is to be used only"'iOi'1'fie ~rpbse ol'a second or subsequent ceremony.
~ 24. TOWN OR C CLEflK :\ 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NA~E (PRINT) _GIO . ~ !
TIME MONTH
SEAL SIOOATURE ~" DATE
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21. SIGNATURE OF GROOM ~
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SIGNATURE ~
DOH-98 (11/9B)
22. SIGNATURE OF BRIDE ~
DATE
by New York Domestic
YEAR
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2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNTY Pu/-(jeJ.J
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF Ii TOWN OF D VILLAGE OF
SPECIFY EfJsr FIS)J K/ L L.
NAME (PRINT)
SIGNATURE ~