007
COUNTY Dutchess
,iii' CITYfTOWN Wappinger
~~~~~CRT 1368
~G~I~J~R 7
>-
Z
W
(f)
W
"'
g
'"
o
I
(f)
Z
o
f=
<<
a:
>-
(f)
i'i
w
a:
w
c:J
<<
ii'
a:
<<
:>
u.
o
w
>-
<<
l)
u:
f=
a:
w
l)
w
a:
w
I
~
(f)
(f)
w
a:
o
o
<<
>-
u.
[)
w
"-
(f)
Ziz
2~B w
~~~ I-
>- wZ <(
"5da5 ()
:> c:J <5 u::
'Z~(f) L:
~(/)u.. r-
O(/)O a:
tEO(/)
0>->- W
w~:3 ()
b~~
Z:J~
A FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Ri~h('lrd A Rnberts
MIDDLE CURRENT SURNAME
I STATE FILE NUMBER I
(THIS SPACE FOR STA TE USE ONL Y)
H-t.{ 'iJ~
L 0 SUPPLEMENTAL FILE ~
11. A. FULL NAME
FIRST
FROM THE BRIDE
Eliza~~th B Carp~nt~fsURNAME
FIRST
"-
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Citta
c. SURNAME AFTER MARRIAGE Roberts
(OPTIONAL. SEE REVERSE I
D. SOCIAL SECURITY NUMBER 156-38-9134
12. RESIDENCE A N lrATEI B. qM~-h~ss
C. CHECK ONE 0 CITY 0 TOWN CJ,;vILLAGE
AND W .
SPECIFY ;::)pprngE'r
D. STREET ADDRESS nn Tnwnview Orivp- ZIP 1 ?~~O
E IS RESIDENCE WITHIN LIMITS. OF CITY OR INCORPORATED VILLAGE? 0 YES cY NO
13. A. AGE "16 13.B. DATE OF BIRTH MolQ / ~R /t~
14. EMPLOYMENT
A. USUAL OCCUPATION Bagging
B. TYPE OF INDUSTRY OR BUSINESS Price Chopper
15. PLACE OF BIRTH I~!]RT~r;J~~s~llersey
16. FATHER
A. NAME Frank Citta
6. COUNTRY OF BIRTH I J S A
17. MOTHER
A. MAIDEN NAME Elizabeth Springer
B. COUNTRY OF BIRTH USA
lB. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEI
o SOCIAL SECURITY NUMBER 059-48- 3664
2. RESIDENCE A N v B nlltr.hess
(STATEI ~I
C CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFY Wappingp-rs F;::llls
o STREET ADDRESS 47 Market Street
ZIP 1 ?~~O
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? cYYES 0 NO
MON1~ / DW / YE1~5
3 A. AGE 49
36. DATE OF BIRTH
!:::
>
oCt
C
u::
u..
Z<(
-<:
4. EMPLOYMENT
A. USUAL OCCUPATION Porter's Work
B TYPE OF INDUSTRY OR BUSINESS pri~e Chnpper
5. PLACE OF BIRTH Pnllnhkppnsip. 1\/pw Y nrk
(ciTy, il'i"t'ElCOUi'1fRY iF~O~USAI
6. FATHER
A. NAME ROllle Roberts
B. COUNTRY OF BIRTH J J S A.
7. MOTHER
A. MAIDEN NAME Mary StOk8S
B COUNTRY OF BIRTH II S A
8. NUMBER OF THIS MARRIAGE ~
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
o 0 1
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2} O~EATH
C. DATE LAST MARRIAGE ENDED? 10/ ~O / 1 Q99
MONTH DA" Y~A~
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES cYf.Jo
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
DEATH
1
o
B. HOW DID LAST MARRIAGE END? (3) cY'DIVORCE 13) 0 ANNULMENT 12) 0 DEATH
C DATE LAST MARRIAGE ENDED? 06/ 14 / ')001
MONTH DAY Y~R
D ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNUL ED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USAI SELF SPOUSE
ffi
OJ
'"
OJ
Z
o
Z
0:
>-
W
W
a:
>-
(f)
1ST 06/14/2001 Poughkeepsie, New York
2ND
3RD
00"
o
o
D
o
o
lJ
o
o
o
o
o
1
w
en
z
w
~
...J
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York Stat of the bride and groom named above by any person authorized
Relations Law S11 to perform marriage ceremonies within 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 CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
25 B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON
by New York Domestic
,-'-..
{ SEAL }
"-y-I
NAME (PRINT)
MONTH
DAY
YEAR
YEAR
TIME
MONTH
SIGNATURE ~
MAILING ADDRESS
AM
PM
200
03
11 2002
01
11
T TE
27. TYPE OF CEREMONY
o ~. RELIGIOUS
9 0 OTHER, SPECIFY
'0 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
29 OFFICIANT J ,
NAME (PRINT) f-.....v
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY ~~-b~ x<-
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF il TOWN OF 0 VILLAGE OF
(' .- '"-:--;:-. 1.1./
SPECIFY r-~' r,~'11
TITLE
SIGN AT E ~
~~~~ A~SS0"L
~
30. WITNESS TO CEREMONY
:::::::: LA ~~~ ,
DOH.98 (11/98)
31
SIGNATURE ~