071
o
<J)
L()
N
.,.-
>-
Z
w
JQ3
-UJ
ro
LL
(/J
'-
Q)
c:: t-
:>
ro <(
$~~
Q)jLL
-><(
2~
G~
Q)G
.:Y-
O
'-
.0
E
Q)
0-
o
r--
.,.-
z z
a: 0 W
:::J i=
>- to-
w "
a: N <(
>- Z
(f) :2 U
:::J w
:2 0 u:
>- (f)
z i=
<( "-
0 0 a:
u:
"- (f) W
0 >-
<( U
w 0
~ UJ
0
Z ~
COUNTY Dutchess
CIT;TOWN Wappinger
~~~~~~T 1368
~5~~~~R 71
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseph D. D'Onofrio
MIDDLE CURRENT SURNAME
I STATE FILE NUMBER I
(THIS SPACE FOR STA TE USE ONL Y)
~Zntl l; 13.r~
Lo SUPPLEMENTAL FILE ~
FROM THE BRIDE
Lauren F. Plattner
A FULL NAME
11 A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
0-
N
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE 0 I Onofrio
(OPTIONAL. SEE REVERSE) 068-60-3930
D SOCIAL SECURITY NUMBER
12 RESIDENCE A. N Y B Dutchess
(STATE) ~ (COUNTY I
C CHECK ONE 0 CITY 0 TOWN 0 VILLAGE
~~~CIFY Wappinger
D STREET ADDRESS 17 0 Pembroke Circle ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES 1"S NO
13 A. AGE 27 13.8. DATE OF BIRTH 04 /22 /1975
MONTH DAY YEAR
BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 129-58-2891
D SOCIAL SECURITY NUMBER
2 RESIDENCE A. N Y B Dutchess
(STATE).L (COUNTY)
C CHECK ONE 0 CITY [J TOWN 0 VILLAGE
~~~CIFY Wappinger
D STREET ADDRESS 17 D Pembroke Circle ZIP 12590
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES t5 NO
08 /03 / 197
YEAR
3 A
AGE 26
DAY
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Legal Assistant
B TYPE OF INDUSTRY OR BUSINESS Finkelstein & Partners
15. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE, COUNTRY IF NOT USA)
4. EMPLOYMENT
A. USUAL OCCUPATION Retail Manager
B. TYPE OF INDUSTRY OR BUSINESS Bed, Bath & Beyond
5 PLACE OF BIRTH Queens, New York
(CITY, STATE/COUNTRY IF NOT USA)
6 FATHER
A NAME Dominick D I Onofrio
B. COUNTRY OF BIRTH USA
7 MOTHER
A. MAIDEN NAME Caroline Vereline
B COUNTRY OF BIRTH USA
B NUMBER OF THIS MARRIAGE 1
9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
16. FATHER
A NAME Morton Plattner
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Sharon Skelly
B. COUNTRY OF BIRTH USA
lB. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
Q Q
DEATH
o
DEATH
Q
B. HOW DID LAST MARRIAGE END? (31:::J DIVORCE
C DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) D DEATH
B. 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? 0 YES 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
MONTH DAY YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? DYES 0 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
D
C
D
D
s
OJ
::>
OJ
z
OJ
z
"
D D 1ST
o 0 2ND
D D 3RD
o 0 4TH
owledge and belief that the information I provided is true
1ST
2ND
3RD
4TH
I, being duly sworn, depose and say, that to the best of my
as to my right to enter into the marriage state.
,}
21 SIGNATURE OF GROOM~' '/
C,/
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New 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 CLE,RK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Glor J Morse
{MONTH YEAR
SEAL SIGNATURE ~
~ M~C~~b 05 30 200
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
w
w
g:
UJ
DATE
by New York Domestic
w
en
z
w
u
::::i
25. S. SOLEMNIZATION PERIOD
ENOS AT MIDNIGHT ON
MONTH
DAY
YEAR
07
28 2002
ZIP
2B PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY~1'2:{C.
1 D CIVIL
12. i3
,"~,~I~:;;; :J::lfl CII1tl.J~AN,v _ TITLE !!II- Jr(;IT~
SIGNATURE ~ _ ~ 4r ------- DATE ~h'z-.
MAI~ADDRESS y~ ~ Ad 109if!'
STREET1 ~'Ii!.J"" .JJ, CITYTOW~ vrrr;f/f S~AT;-/
30 WITNESS TO CEREMONY 31 WITN[OSS TO
1L,
OTHER, SPECIFY
C LOCATION OF CEREMONY
(CHECK ONE AND ,yCIFY)
iJ CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY
~~r
NAME (PRINT)
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/9B)
SIGNATURE ~