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Dutchess
COUNTY Wappinger
CITYrrollr'~
DISTRICTI...68
~~~I~~~F34
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Peter R. 5chm idt
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
JtJ't
6 .J/tf -t'0
L 0 SUPPLEMENTAL FILE
I
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FROM THE BRIDE
Laureen Mane Daily
1. A FULL NAME
11 A. FULL NAME
FIRST ~LE
B. BIRTH NAME (MAIDEN NAME),(!'.DlffERCN..l. Ipa
~cnmlm
C s~g~~~N~~E~~t~~e~~SEi'126-66-9308
D. SOCIAL SfiClJeRlwTY ~.MOBEj-
NI T C rK uutchess
12 RESIDENCE A. B
CURRENT SURNAME
B. HOW DID LAST MARRIAGE END? (3) 0 DIV1)li , n1NNULM./199fF DEATH
C. DATE LAST MARRIAGE ENDED? MON"'" - 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
1ST oEf)()1l19913(:attneei.f~~V6rk NOT USA) S~ SPO~E
2ND 0 0
3RD 0 0
o 0
pediment e~ists
,
FIRST
MIDDLE
CURRENT SURNAME
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N
B BIRTH NAME. IF DIFFERENT
C s~g~~~JN';;LTE~~t~~e~~s~9 '1-64-464 7
D SOCIAL Sl1J~ylL.lf8f'k
2 RESIDENCE A. (STATE).1 B. (COUNTY)
C CHECK 0tjii,1 .il_G.ITY 0 TOWN 0 VILLAGE
AND U ennam
SPECIFY 84-A Old Glenham Road
D STREET ADDRESS
Uutchess
12521
(STATE)'" (COUNTY)
C CHECK IX. hCL.CITY 0 TOWN 0 VILLAGE
AND I,jolen am
SPECIFY M-A Old GI~f1harn RUl:Id
D. STREET ADDRESS
ZIP
.,.
E IS R~I&NCE WITHIN LIMITS OF CITY OR INCORPORATEnVfLAGE? A 8 0 YES .H..~
3 A. AG~ 3B. DATE OF BIRTH 2 ~
MONTH DAY YEAR
E. IS R~~NCE WITHIN LIMITS OF CITY OR INCORPORAT'01LLAGE? 77 0
13. A. AGE 13.B. DATE OF BIRTH ~
MONTH DAY
4. EMPLOYMENT
14 EMPLOYMENT
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A. USUAL OCCUPATION D Ir D 5 rvI
"usse S oor e ce
B TYPE OF INDJJ'e~IfSk~1f.IWiw York
5. PLACE OF BIRTH '
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER Th d 5 h -dt
eo ore c ml
A. NAME USA
B COUNTRY OF BIRTH
House Mom
A. USUAL OCCUPATION AI U
M. I lame
B. TYPE OF INDI,ISTR'y~R BU~i>S~
LaWlon UKI8110ma
15. PLACE OF BIRTH '
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER "
Vincent Tipa
A. NAME t1 5 A
B. COUNTRY OF BIRTH
17. MOTHER L" d R" h d
A. MAIDEN NAME In a IC ar s
B. COUNTRY OF BIRTtV 5 ~
18. NUMBER OF THIS MARRIAGE
7. MOTHER
A. MAIDEN NAME Margaret Kenney
B COUNTRY OF BIRTH U 51 A
8 NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL A'(fULMENT
Db'TH
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A'(fULMENT
vi
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
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
a:
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21 SIGNATURE OF GROOM ~
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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 S te of the bride and groom named above by any person authorized
Relations Law S11 to perform marriage ceremonies with' 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 cGl&ff~KJ Morse 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
04/11/2002 TIME MONTH YEAR
SEAL SiGNATURE.... 1
'-v-' ~ErMI r Falls, NY 12590 1:12 AM 04 12
STREET STATE ZIP PM
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
MONTH
YEAR
2002 06
tI'
Y!lffi~O
YEAR
DltTH
10 2002
o 0 RELIGIOUS
1% CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTyJ,u-rrffCS;:::
9 0 OTHER, SPECIFY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF f;5.. TOWN OF 0 VILLAGE OF
SPECIFY tJ fir Pi tJ G- J:,e.
29 OFFICIANT
NAME (PRINT)
TITLE~/11r€f2~~orcc€ #2
DATE //lift.( :23., ~() z.
a'I'JPffJjc:;.e4'<:J' fr;;f..L$ A.ll/;:2-.5 0
CITY TOWN STATE ZIP
31. WITNESS TO CE.REMONY
('
NAME (PRINT)
SIGNATURE ~
NAME (PRINT)
SIGNATURE ~
DOH-9B (11/98)