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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Gr~grlY A Sm~~~i!~T SURNAME
1ST 12/24/2001 Poughkeepsie, New York 0 cY' 1ST 11/01/2000 Melbourne, Australia 011 []
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the Information I provided IS true and that I declare that no legal Impediment eXists
as to my nght to enter Into the marr g state l' (\, ·
21 SIGNATURE OF GROOM ~ GNATUR~ OF BRIDE ~"-./,~, ~1 )...(Q ~ ^ '
..." " USecURRENT NAME
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of the bride and groom named above by anY-person authorized by New York Domestic
Relations Law ~11 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
COUNTY Dutchess
CI,TvrroWN Wappinger
~~J~~CRT 1368
~G~'~J~R 4
A FULL NAME
FIRST
BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER 07?-40-~44~
2 RESIDENCE A N Y B. nlJtche~~
(STATE 1 (COUNTY)
C CHECK ONE 0 CITY 0 TOWN rg VILLAGE
~~~CIFY Wappingers Falls
D STREET ADDRESS 8 Dutchess Avenue
ZIP 12590
r!I YES 0 NO
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE 46 38. DATE OF BIRTH
4 EMPLOYMENT
A. USUAL OCCUPATION MFlintenance Worker
B. TYPE OF INDUSTRY OR BUSINESS St Cabrini Home~ Inc
.
5 PLACE OF BIRTH Bronx New York
(CITY, STATE/COUNTRY IF NOT USA)
6 FATHER
A. NAME William SmFlrrito
B COUNTRY OF BIRTH l J S A
7. MOTHER
A. MAIDEN NAME Antoinette Saitta
B. COUNTRY OF BIRTH Sir.ily, Italy
8 NUMBER OF THIS MARRIAGE ?
9 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
1 0 n
B HOW DID LAST MARRIAGE END? (3) r!lDIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C DATE LAST MARRIAGE ENDED? 12/ 24 / ?OO 1
MONTH OA Y yt,(R
o ARE ANY FORMER SPOUSE(S) ALIVE? [YYES 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
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
{wnt
,"
( ~1'6' t l1j
L D SUPPLEMENTAL FILE
FROM THE BRIDE
J=inn;:! .Ie;:!n Mir.pli
MIDDLE CURRENT SURNAME
.J
11. A. FULL NAME
FIRST
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT Blackley
C SURNAME AFTER MARRIAGE Miceli - Smarrito
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER
12. RESIDENCE A. NY B. n,lf("hp~~
(STATE) ~)
C CHECK ONE 0 CITY 0 TOWN [Y"vILLAGE
~~~CIFY WFlppinge~ Fall~
o STREET ADDRESS 8 Dutchess Avenue ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? C'l'" YES 0 NO
13. A. AGE 38 13.B. DATE OF BIRTH MOQ~ / ~A4 /t~R3
14. EMPLOYMENT
A. USUAL OCCUPATION Arfmini~trFltivp A~~i~tant
8. TYPE OF INDUSTRY OR BUSINESS l Jnemployed
15 PLACE OF BIRTH ~,~n!~~~~Tfv'~~fm~
16. FATHER
A. NAME Harry RI;:!r.kley
B. COUNTRY OF BIRTH Scotl;:!nrf
17. MOTHER
A. MAIDEN NAME Ann Latham
B. COUNTRY OF BIRTH E=ngland
18. NUMBER OF THIS MARRIAGE ?
19. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 n
DEATH
o
8. HOW DID LAST MARRIAGE END? (3) Oi"'DIVORCE 131 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 11 / 01 / ?Anoo
MONTH DAY '7r.il\'
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 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
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{ SEAL }
'-v-I
NAME (PRINT)
DATE 01/07/2002
ZIP
AM
02:46PM
08 2002
STRE ET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
o~
D'5() RELIGIOUS
9 0 OTHER, SPECIFY
DATE
01107/?OO?
TIME
MONTH
YEAR
MONTH
YEAR
08
01
200
03
10 CIVIL
28 PLACE WHERE MARRIAGE OCCURRED /J./ -r .
A STATE NEW YORK B COUNTY M /1/191'1
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF X'f TOWN OF [J VILLAGE OF
SPECIFY t! rl /f /1 c--L
~
TITLE 6Rl> /YINI$~
/It/"'I
IV\.
DATE
/t)S/;<
STATE ZIP
31'WITNESSTO~CER~NY' . .
NAME (PRINT) _~
SIGNATURE ~