016
]
0-
N
W
fo-
<<
fo-
<fJ
fo-
Z
W
U)
W
'"
g
:J
o
I
U)
Z
o
>=
<<
a:
t-
U)
a
w
a:
w
'"
<<
a:
a:
<<
:2
lL
o
W
t-
<<
o
u:
>=
a:
w
o
w
a:
ill
I
;;
U)
U)
w
a:
o
o
<<
>-
lL
o
w
0-
U)
z z
~ 2 UJ
~ ~ ....
t- Z <C
~ a1 U
~ 8 u:::
~ 6 t=
u: a:
o ~ L1J
W 0 U
I- "'
o
z <::
. Dutchess
COUNTY W~ppinger
CiTYiT01'3
DISTRICT ..J68
~~~'~~~R 16
NUMBER
STATE OF NEW YORK I (THISS::;;~~~~~~~:~~EONLY) 1 :l
DEPARTMENT OF HEALTH :{ .Jh .tJ~' Ca,I.&l /~#t>/Ila '"JII119' !tit
AFFIDAVIT, LICENSE and 1/1Jj~~ 1l?Z /ztiF 1J,{!~l: 'af~ tlfJ;",0
CERTIFICATE OF "-0 {117J4t2lMf, Vetif)~llfly
MARRIAGE L 0 SUPPLEM-EN1AL FILE 'l'-~I ~
FROM THE GROOM
Gerald E. Falco
A FULL NAME
11. A FULL NAME
FROM THE BRIDE
Marilyn V. Sgambati
FIRST
MIDDLE
CURRENT SURNAME
FIRST
MIDDLE
CURRENT SURNAME
B BIRTH NAME. IF DIFFERENT
B BIRTH NAME (MAIDEN NAME), 'M'F~ERENT
C SURNAME AFTER MARRIAGE a co
(OPTIONAL' SEE REVERSE) 127-74-9530
SOCIAL SE~RITY NU~BER
12 RESIDENCE A ew york B Dutchess
(STATE) ~ (COUNTY)
C. CHECK QtJ~. 0 CITY 0 TOWN 0 VILLAGE
~~~CIFY vvapplngers Falls
o STREET ADDRESS 1 ~ tast Main ~treet Apt. i!
C SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)1 06-62-5~
o SOCIAL SEi;,lJ~ITY N~ER
New york uutchess
2 RESIDENCE A. B
(STATE) ., (COUNTY)
C CHECK ONl'.. .J:l <;.!TY D ~O~ 0 VILLAGE
AND vvapp.ngers J!"a.1.ls
SPECIFY
15 East Main Street Apt. 2
o STREET ADDRESS
125!iO
ZIP 12590
oJ'
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
13 A AGE22 13.B DATE OF BIRTH 09 ,;07
ZIP
oJ'
E IS RE~~NCE WITHiN LIMITS OF CITY OR iNCORPORATEDoaLAGE? 0 YES.Q NO
3. A. AGE 38 DATE OF BIRTH flO L!. 918
MONTH DAY YEAR
YES 0 NO
}919
YEAR
MONTH
DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Unemployed
4 EMPLOYMENT
....
:>
<C
c
w-
,-"u..
:'iu..
~<C
z
~
o
t:
>-
fo-
o
Laborer
A. USUAL OCCUPATION C
B. TYPE OF IND~TRY ;kftBl!.SI1ijjS hep uepot
5. PLACE OF BIRTH roo "YfI, ew York
(CITY, STATE/COUNTRY IF NOT USA)
6 FATHER G . F I
A NAME enano a co
8 COUNTRY OF BIRTH USA
8 TYPE OF INDUSTRY OR BUSINESS
15 PLACE OF BIRTHJamaica, New York
(CITY, STATE/COUNTRY IF NOT USA\
16. FATHER
A. NAME Pasquale Sgambati
B COUNTRY OF BIRTrf"ap'es, Italy
17 MOTHER
A. MAIDEN NAME Marilyn Libero
8 COUNTRY OF BIRT~arce'ona, Spain
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL AOULMENT
7 MOTHER
A MAIDEN NAME Laura Hixon
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~ULMENT
DEATH
o
DliTH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(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? 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
ffi
<Il
:2
::J
Z
o
z
<<
fo-
W
W
a:
fo-
'"
o
o
o
o 1ST
o 2ND
o 3RD
o 4TH
belief that the information I provided is tr
22. SIGNATURE OF BRIDE ~
21 SIGNATURE OF GROOM ~
w
en
z
w
U
::::i
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 by New York Domestic
Relations Law ~11 to perform marriage ceremonies withi New York Slate. 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 CJ:('(OCl"ERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) ul' na ...
{. TIME MONTH YEAR MONTH
SEAL SIGNATURE ~
'-v-" M2'6~~ush Rd, 2:53 ~~ 02 22 2002 04 22 2002
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
YEAR
STATE ZIP
27 TYPE OF CEREMONY /
o 0 RELIGIOUS 1 [it"CIVIL
9 0 OTHER, SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
A STATE NEW YORK B COUNTM,rr-~
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN:'" r0ILLA~
SPECIFY tyA-PPi ~~
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/98)