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Dutchess
COUNTY W .
appllly..:r
CITYrrow"68
DISTRICTI,,)
~~~,~~~Fl2
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM .
Angelo A. Semlsa
I
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
4M~t
J
~f -1ft, - PV)
L 0 SUPPLEMENTAL FILE
~
1 A FULL NAME
11 A. FULL NAME
FROM _THE BRIDE .
Mane A. Magarelh
FIRST
MIDDLE
CURRENT SURNAME
FIRST
MIDDLE
CURRENT SURNAME
0-
N
BIRTH NAME. IF DIFFERENT
B BIRTH NAME (MAIDEN NAME),~rnU~N8
C s~~~~~JN~LT~~~t~~e~~SE) 152-42-8848
o SOCIAL S~~wT&lIk Dutchess
12. RESIDENCE A. (STATE)'" B (COUNTY)
C ~~6CK <w'appmgeY 0 TOWN 0 VILLAGE
SPECIFY 26F Alpille Drive
o STREET ADDRESS
C s~~~~~JN~~E~~t:e~~sEJI 00-44-6820
o SOCIAL SEN~W'Hfk Dutchess
2 RESIDENCE A. (STATE).) B. (COUNTY)
C ~~6CK O'Wappm~er 0 TOWN 0 VILLAGE
SPECIFY 26F Alpille Drive
o STREET ADDRESS
12590
ZIP
"
E IS R~~NCE WITHIN LIMITS OF CITY OR INCORPORATlj~LLAGE? M 0 Y~~ NO
13 A. AGE 13.B. DATE OF BIRTH ~ ~9
MONTH DAY YEAR
v
E IS R~:JNCE WITHiN LIMITS OF CITY OR INCORPORATED1VtLAGE? 280 YES ~~~
3 A. AGE 3B DATE OF BIRTH /" ~
MONTH DAY YEAR
4 EMPLOYMENT M
anager
A. USUAL OCCUPATION Midas
B. TYPE OF IND~TRY QB BUSINii~ .or.
5. PLACE OF BIRTHosysnore, New YO, n.
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER F k S .
ran emlsa
A. NAME USA
B COUNTRY OF BIRTH
14. EMPLOYMENT
Hairdresser
A. USUAL OCCUPATION Fir Cut
an as IC s
B TYPE OF INDIJ~TR.'!' OR BUSINf'ilS J
nODOKen New ersey
15. PLACE OF BIRTH '
(CITY, STATE/COUNTRY IF NOT USAI
16. FATHER J h M II"
o n agare I
A. NAME II fy
B COUNTRY OF BIRTH a
7. MOTHER
17. MOTHER M
A. MAIDEN NAME ary Ann Carparo
B COUNTRY OF BIRTJJ S ~
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A~ULMENT
DI(tTH
Irene Barrera
USA
B. COUNTRY OF BIRTH 3
8 NUMBER OF THIS MARRIAGE
A. MAIDEN NAME
9 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV~RCE CIVIL A'lfULMENT
D{fTH
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B. HOW 010 LAST MARRIAGE END? (3) 0 DIVOrJt (3) , tfNULMENT20JJf DEATH B. HOW 010 LAST MARRIAGE END? (3) 0 DIVO~C1 /(3) 2rNULM/EN19~~ DEATH
C DATE LAST MARRIAGE ENDED? . / / C. DATE LAST MARRIAGE ENDED? MON-JI - -
MONM DAY YEAR ,..- DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
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
1 ST ftfI6Vf98~~o~g'hf.Teeps~e:Ne~T foHc SELF SPO~E 1 ST O~n(}ff98~~o~QhfcTeeps~e,RNe~T foHc SELF SPO~E
07 It 8/200 I Poughkeepsie, New Tort .j;joI 0 111271'1995 PoughkeepsIe, New Y ort 0 ~
2ND 0 0 2ND 0 D
3RD 0 0 3RD 0 D
4TH 0 0 4TH 0 D
I, being duly sworn, depose and say, tRilUothe best 0 and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the m. e;-::~..__
='...,.. -:....~.~
22. SIGNATURE of BRIDE ;r,
21 SIGNATURE OF GROOM ~
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23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ 0 TE
This license authorizes the marriage in New York the bride and groom named above by any person authorized
Relations Law S11 to perform marriage ceremonies wit n 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 CC3l8ff~KJ" Morse 25. A. SOLEMNIZATION PERioD BEGINS
NAME (PRINT)
DAY
YEAR
25 B SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON
~
{ SEAL }
'-y-I
YEAR
MONTH
TIME
MONTH
SIGNATURE ~
M2EY'Miffi!fiffiush Rd,
ZIP
AM 03
3 :09 PM
2002 05
11 2002
13
STATE
27. TYPE OF CEREMONY
o ~RELlGIOUS
9 0 OTHER, SPECIFY
CITY,TOWN
26. SOLEMNIZATION OCCURRED
TIME MO. OAY YEAR
1 D CIVIL
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICA TED
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY lxYK'J.ip:r-S
-3 :::x) AM - 12 -02
noee",," "~.l ~~b
NAME (PRINT) ~' I.. '.'
SIGNATURE ~ il"L ~ .
MAILlN~DRESS / _
"2 .L'CLAV,.W AUE, ~(P\U
S REET CITY;TOWN I
30. WITNESS TO CEREMONY __
~IJEJ
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
rA. CITY OF 0 TOWN OF
SPECIFY j)(;;l\((lJ....)
C VILLAGE OF
Mlk)\"S~
TITLE
DATE A~L lZ. a-::62-
I
.6JElu '*, 2J.L I2..SQ3
f STATE ZIP
31. ONY
o
NAME (PRINT)
~
SIGNATURE