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COUNTY Dutchess
CITYiTOWN Wappinger
1368
51
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Angelo J. Migliore
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y) 1
I
,1U. ,0 J...
'G ' J\.\
I
@~!
DISTRICT
NUMBER
REGISTER
NUMBER
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Melissa D. Barger
MIDDLE CURRENT SURNAME
~
A FULL NAME
11 A. FULL NAME
FIRST
FIRST
B BIRTH NAME. IF DIFFERENT
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE M jgliore
(OPTIONAL. SEE REVERSE) 054-58-3233
D SOCIAL SECURITY NUMBER
12 RESIDENCE A New Yark B Dutchess
(STATE I oJ (COUNTY)
C. CHECK ONE D CITY D ,OWN D VILLAGE
~~~CIFY Wappinger
D STREET ADDRESS 323 Chelsea Cay
12590
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 099 70 3611
o SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess
(STATE) ~ (COUNTY)
C CHECK ONE D CITY D TOWN D VILLAGE
~~~CIFY Wappinger
o STREET ADDRESS 323 Chelsea Cay
12590
ZIP
ZIP
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE' DYES =.....NO
05 / 06 /1973
MONTH DAY YEAR
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE'
3 A AGE 28 3B. DATE OF BIRTH 07 /
DYES D.....NO
16 / 197
DAY YEAR
13 A AGE
29
13B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
14. EMPLOYMENT
A. USUAL OCCUPATION
Sales
A USUAL OCCUPATION Office Manager
B TYPE OF INDUSTRY OR BUSINESS Empire state Marble
5 PLACE OF BIRTH Cold Spring, New York
(CITY, STATE'COUNTRY IF NOT USA)
B. TYPE OF INDUSTRY OR BUSINESS Brown Shoe Corporation
15. PLACE OF BIRTH Tarrytown, New York
(CITY, STATE,COUNTRY IF NOT USA)
16 FATHER
6 FATHER
A. NAME John Barger
B. COUNTRY OF BIRTH USA
17. MOTHER
A. NAME Salvatore Migliore
B COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Laura Del Monte
B COUNTRY OF BIRTH USA
1
Anqelina Monaco
B COUNTRY OF BIRTH USA
8 NUMBER OF THIS MARRIAGE 1
A. MAIDEN NAME
18. NUMBER OF THIS MARRIAGE
9 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
19. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END' (3) D DIVORCE
(3) D ANNULMENT
/ /
(2) D DEATH
B HOW DID LAST MARRIAGE END' (3) D DIVORCE
C DATE LAST MARRIAGE ENDED'
(3) 0 ANNULMENT
/ /
(2) '= DEATH
C DATE LAST MARRIAGE ENDED'
MONTH DA Y 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
D
MONTH DAY YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE' [] YES D 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
21 SIGNATURE OF GROOM ~
D D 1ST
D D 2ND
D D 3RD
D D 4TH
the b~t of my knowledge and belief that the information I provided is true and t
. 1 , .. ,
I
DO
D n
re that no legal impediment exists
CJ
22 SIGNATURE OF BRIDE ~
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23 ~~~;T~~~DC:Nlo~~O~~ ~~yBg~~K ~E DAJi 05/06/2002
This license authorizes the marriage in New York State of autho ired by New York Domestic
Relations Law S 11 to perform marriage ceremonies within N 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 CITYG1ERj 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
~
{ SEAL }
'-y-I
05
YEAR
TIME
MONTH
DATE 05/06/200
ap nger Falls, NY 12590
CITYrTOWN STATE ZIP
27. TYPE OF CEREMONY
--
SIGNATURE ~
MAIL~O"M/(fmebush R
AM
01 :OaM
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY fJ...+J.e u
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
[J CITY OF ~ TOWN OF C V~LLAGE OF
SPECIFY ~ ~,-h kfi!e.l~'e.--
Q I
26 SOLEMNIZATION OCCURRED
TIME MO DA Y YEAR
1)X
CIVIL
o D RELIGIOUS
9 D OTHER, SPECIFY
29 OFFICIANT
NAME (PRINT)
;-4-,- 7fl
>' /;f/o'L.-
, 'I /2~/
TITLE
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/98)