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COUNTY Dutchess
CITYiTOWN Wappinger
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A FUll NAME
ST ATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Frank S Perri
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Allison M Orlando
MIDDLE CURRENT SURNAME
~
11. A. FUll NAME
FIRST
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C SURNAME AFTER MARRIAGE Per r i
(OPTIONAL. SEE REVERSE) 2 5
o SOCIAL SECURITY NUMBER 110-7 . -96 9
12 RESIDENCE A N Y B Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY D~OWN 0 VilLAGE
AND W .
SPECIFY applnger
D STREET ADDRESS 57 Brothers Road ZIP 12590
BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 130-68-4019
o SOCIAL SECURITY NUMBER - -- -- -- --
2 RESIDENCE A N Y B Dutchess
ISTATE) (COUNTY)
C CHECK ONE 0 CITY []ITOWN L' VILLAGE
~~~CIFY Wappinger
o STREET ADDRESS 93 Hackensack Heiohts ZIP 12590
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VillAGE? 0 YES ~...,. NO
O~ /?7 /1m4
MONTH DAY YEAR
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VillAGE? 0 YES cI NO
11 / 10 / 1m
MONTH DAY YEAR
3. A
AGE ;7
3B. DATE OF BIRTH
13. A. AGE ?7
13.B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Insurance Representative
B TYPE OF INDUSTRY OR BUSINESS Daniels Agency
15. PLACE OF BIRTH White Plains. New York
(CITY. STATE/COUNTRY IF NOT USA)
4 EMPLOYMENT
A USUAL OCCUPATION Union Sheet Metal Worker
B TYPE OF INDUSTRY OR BUSINESS Local 38
5. PLACE OF BIRTH Carmel New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A NAME Michael Orlando
B COUNTRY OF BIRTH USA
17. MOTHER
6. FATHER
A NAME John Perri
B COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME SII!'=:::In (.;rnnkp
B COUNTRY OF BIRTH USA
8 NUMBER OF THIS MARRIAGE 1
9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
A MAIDEN NAME N::Inr.y Sllmm::l
B COUNTRY OF BIRTH USA
1
1 B NUMBER OF THIS MARRIAGE
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) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) :J DEATH
B HOW DID lAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
MONTH DAY YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? 0 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
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ::::: YES 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
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15T 0 0 15T 0 0
2ND 0 L' 2ND 0 C
3RD 0 0 3RD 0 ' '
4TH 0 0 4TH 0 0
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that~egal impediment exists
as to my right to enter into the marria state. -J 0" U-. (l,... vv-l '
21 SIGNATURE OF GROOM ~ /~ 22. SIGIiATURE OF BRIDE ~ .oO..l..L)2() . kJ/()i,J I LD
USE CURRENT NA USE CURRENT NAME
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DATE
04/19/2002
by New York Domestic
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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 persDn authorized
Relations Law 911 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 Df a second or subsequent ceremony.
24 TOWN OR CITY CLERK 25. A SOLEMNIZATION PERIOD BEGINS
TIME
MONTH
~
{ } NAME (PRINT
SEAL SIGNAT~ DATE 04/19/200
~ MAI~N8 M~ddl~bu
STREET ap~~T~~! Falls. ~YrE 12590 ZIP
~~~R~~~R:~~~ 10~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27 TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO DAY YEAR O.Q(.RELlGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND lJ
PLACE INDICATED :J.:oC' p CJ>'-- 07 2N)~ 90 OTHER. SPECIFY
AM
02: 4Q>M
04
28 PLACE WHERE MARRIAGE OCCURRED
A. STATE NEWYORK B COUNTy'D,}iC.II-'i.r.5
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF 2("VILLAGE OF
SPECIFY P;91A./ J.-~"r &-
29 OFFICIANT
NAME (PRINT)
TITLE
R.C,
? A'J:r .! ./
DATE
PAW /,..;r'tV 6.
BOG
31
NAME (PRINT)
SIGNATURE ~
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/98)