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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM_THE GRBOM
.K.enneth apolongo
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
d1jmr19~pofJgh~e~p~e~NeW f~~ SELF SPOlJ1E mf.ti"f1'9grPoijghV.~Tep~~N'~~ SE',j! SPOUSE
1ST 01/2211993 King5lofl, Ne::w York 0 D 1ST 0
2ND 0 0 2ND 0
o 0 3RD 0
o 0 4TH
dge nd belief that the information I provided is t
()
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York St e of the bride and groom named above by any person authorized
Relations Law S 11 to perform marriage ceremonies within ew 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 Crll8nf . Morse 25. A SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) .
_ TIME MONTH
SEAL SIGNATUR!=~
'-v-I M'2&'MR!Jalebush Rd,
Dutchess
COUNTY W .
applllY~1
CITYITOlil'J 68
DISTRICTI>}
~~~1~~~~8
NUMBER
1. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
BIRTH NAME. IF DIFFERENT
C s~~~~~JN~LTE~~::e~~sD85-54-0 160
D SOCIAL sEf!JeW'Hfk Dutchess
2 RESIDENCE A. (STATE)..1 B. (COUNTY)
C ~H5CK O'Wappwhgler 0 TOWN 0 VILLAGE
SPECIFY '31 Alp~ll Olive 12::'90
D STREET ADDRESS ZIP ..
E. IS R~:JNCE WITHiN LIMITS OF CITY OR INCORPORATEiftLAGE? ~ 8 0 YES :t9~~
3. A. AGE 3B. DATE OF BIRTH / /
MONTH DAY YEAR
4. EMPLOYMENT Analyst
A. USUAL OCCUPATION IBM
B TYPE OF IND~1iB~QR,iW,lS.lNfS.S r'" .. It
vvnne t"laln5 'lIew T 01
5. PLACE OF BIRTH '
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER Aniello Capolongo
A NAME USA
B COUNTRY OF BIRTH
7. MOTHER Ehn C it
mra arpen 0
A MAIDEN NAME uSA
B COUNTRY OF BIRTH '3
B NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVTCE CIVIL A~ULMENT
Dl1TH
.!
B HOW DIO LAST MARRIAGE END? (3) 0 DIVO'(jy (3) ~NULMENT'l gg31 DEATH
C DATE LAST MARRIAGE ENDED? . / /
MONl'I'!' DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
ffi
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21 SIGNATURE OF GROOM ~
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(THIS SPACE FOR STATE USE ONL Y)
B.rmt
if- ~ G()~
L 0 SUPPLEMENTAL FILE
~
FRO~Jptfail\~IR~alile
"Saba
B BIRTH NAME (MAIDEN NAMEI.C~lOOgo
C. s~~~~~N~~~~:~~e~~SE)11 3-60-7956
D SOCIAL SR~Nif'6rt Dutclless
12. RESIDENCE A. (STATE).... B. (COUNTY)
C ~H5CK Wappinger 0 TOWN 0 VILLAGE
SPECIFY 31 Alpcf\ Drive
D STREET ADDRESS
11. A. FULL NAME
FIRST
CURRENT SURNAME
12500
ZIP
,"
E. IS R~~NCE WITHIN LIMITS OF CITY OR INCORPORATI{)~LLAGE:; 1 0 Y'fQA4NO
13. A. AGE 13.B. DATE OF BIRTH - ~
MONTH DAY YEAR
14 EMPLOYMENT Programmer
A. USUAL OCCUPATION IBM
B. TYPE OF INDp8Ugf\R~Sle, New York
15. PLACE OF BIRTH
(CITY. STATE/COUNTRY IF NOT USA)
16 FATHER Ignatius Saba
A. NAME USA
B. COUNTRY OF BIRTH
17. MOTHER Jacqueline Dalton
A. MAIDEN NAME USA
B. COUNTRY OF BIRTH 2
lB. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIlfORCE CIVIL AtflIULMENT
oJ
DIl}TH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVens (3) l11NNULMEN:'199'P OEA TH
C. DATE LAST MARRIAGE ENDED? ... / /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
22. SIGNATURE OF BRIDE
DATE
by New York Domestic
ZIP
12:21 ~~ 04
YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICAT. D
STATE
27. TYPE OF CEREMONY
RELIGIOUS
OTHER, SPECIFY
CIVIL
2B PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUN~
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
[j CITY OF C TOWN OF ~AGE OF
SPECIFY ~A1'f'Ii\:6~ ~
31. S TO CEREMQ~ " . ___ }
NAME (PRINT) .. J Ik f-AvC S- J;XL...;> ~ 0
~/ ~
SIGNATURE ~