021
]
LI
en
~
N
......
~
L..
5!-
5:~
(1)>'
U!
Z
(I)
m
....l1... I-
~~ :>
wCD <(
tD C
gC UJ-
60.." u..
~a..ju..
z~;;; <(
QS ~
~ 0
g:,,; ~
(f)'\.IJ t:
aI'- u
~
wCD
~"S
g;o
~
"-
Of')
~
~r-
>=
a:
w
o
w
a:
w
I
~
(f)
(f)
w
a:
o
o
'"
i::
o
w
"-
(f)
z z
~ 2 w
w '" I-
~ ~ <I:
"3 ~ U
~ 8 u::
~ is i=
u:: a:
o ~ W
Iii 0 U
I- U!
o
z ~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christopher J" Leonetti
21 SIGNATURE OF GROO
23. SUBSCRIBED AND SWOR~TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York Stat of
Relations Law 911 to perform marriage ceremonies within w 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 Dr subsequent ceremony.
24. TOWN OR C!):.Y.,CLERKJ M 25 A SOLEMNIZATION PERIOD BEGINS
I"j ona " orse . .
NAME (PRINT)
Dutchess
COUNTY
Wappinger
CITY,T01'3
DISTRICT .:168
~~~'~~~R 21
NUMBER
1. A FULL NAME
MIDDLE
CURRENT SURNAME
FIRST
"-
N
8 BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE05&-46-86ti9
D SOCIAL SE~~~V8rk Dutchess
2 RESIDENCE A. ISTATEI.,j B
C. CHECK ONf"" .IJ ~TY 0 TOWN 0 VILLAGE
AND vvapplnyer
SPECIFY 1553 Route 376
D STREET ADDRESS
(COUNTY)
12590
ZIP
."
E IS RE~~NCE WITHIN LIMITS OF CITY OR 'NCORPORATEDO',LAGE? 0 YES ~ ~
3 A AGE 3B. DATE OF BIRTH /28 / 9
MONTH DAY YEAR
4. EMPLOYMENT S If I d
A. USUAL OCCUPATION e -emPLoye S
Ifll0USlne ef\llCe
8. TYPE OF IND~TRY OR BJ.I~INES~ _
5. PLACE OF BIRTHoronx, New york
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER J h L tt"
A. NAME 0 n eone.!
B COUNTRY OF BIRTH U ~ A
7. MOTHER . .
A. MAIDEN NAME Annamana Clorra
B COUNTRY OF BIRTH Italy
1
8. NUMBER OF THIS MARRIAGE
9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV'(fCE CIVIL A~ULMENT
D~TH
B HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C, DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
a:
UJ
CD
:>
::>
z
o
z
'"
....
UJ
UJ
a:
....
U!
1ST
2ND
3RD
4TH
I, being duly sworn, depose and
as to my right to enter into the
UJ
en
z
w
U
:J
~
{ SEAL}
'-v-I
;I.A.k.1 DATE 03/06/2002
r FalJs, NY 12590
12:46 ~~ 03
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
1.1;1 ,i
11
ij)h-;;;,i,
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Maureen B" C1 Connell
~
11. A FULL NAME
FIRST
MIODLE
CURRENT SURNAME
B BIRTH NAME (MAIDEN NAME), IQYF(::RENT
C. SURNAME AFTER MARRIAGE onnen - Leonetti
(OPTIONAL - SEE REVERSE)U~ti-tiU-l:S {tiU
D SOCIAL SE(;~e'TwY NI.!~OBEf\.-
N. Y rK Dutchess
12. RESIDENCE A, (STATE)" B, (COUNTY)
C. CHECK ~i, IJ.. CITY 0 TOWN 0 VILLAGE
AND wappInger
SPECIFY '1553 Route 376
D STREET ADDRESS
'12590
ZIP
tI'
Y~90
YEAR
E. IS REJiNCE WITHIN LIMITS OF CITY OR INCORPORATED lLAGE? 0
13. A. AGE 13.8. DATE OF BIRTH 1 ~1
MONTH DAY
14. EMPLOYMENT . .
A USUAL OCCUPATION Opttclan
8. TYPE OF INDLJATRY OR BI.i~INES~ ~ye c:are
15. PLACE OF BIRTHvronx, New york
(CITY, STATE/COUNTRY IF NOT USA)
16, FATHER . ~
A NAME Patnck C1 ...onnen
8. COUNTRY OF BIRTHU ~ A
17. MOTHER
A. MAIDEN NAME Noreen Broderick
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DI60RCE CIVIL Al:jULMENT
DEOTH
8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
1ST
2ND
3RD
4TH
t t~_e information I provided is true an
[J 0
o 0
o 0
o 0
hat I declare j\1,t jO.Jjal impediment ~ists
) . (!) [;;/J #
USE CURRENT NAME
03/06/2002
22, SIGNATURE OF BRIDE ~
DATE
by New York Domestic
TIME
MONTH
YEAR
ZIP
CITY TOWN
26 SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
STATE
27. TYPE OF CEREMONY
o~ RELIGIOUS
9 0 OTHER. SPECIFY
10 CIVIL
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
j~, 1CO
29 OFFICIANT~~D E~ t ,. 'A. ~ tt
NAME (PRINT) I, " \IV........, TITLE
SIGNATURE~__-""'-- A )~ DATE
'+ 2'6 H(l?cWt::LL \J"c..T.
STATE
CITY OWN
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98) /
28 PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNT~~ hf'<,5
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
[J CITY OF }(. TOWN OF 0 VILLAGE OF
SPECIFY [; A s-r
R . c. ? R I E. 5/
t"-f;s-D'2.-
tJ '2.5' 33
FlSH KILL-
31,
NAME (PRINT)
SIGNATURE ~