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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseph Frank Ciraolo, II
MIDDLE CURRENT SURNAME
COUNTY Dutchess
C1TYfTOWN Wappinger
~~J:~c:1368 .
~5~~J~R46
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEb62_70_1668
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY~ TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D. STREET ADDRESS 8 Benton Road ZIP 12603
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES"'D NO
11 /10 /1984
MONTH DAY YEAR
3. A. AGE 25
3B. DATE OF BIRTH
l-
S;
4. EMPLOYMENT
A. USUAL OCCUPATION Construction
B. TYPE OF INDUSTRY OR BUSINESS Construction
5. PLACE OF BIRTH Mount Kisco , NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Joseph Frank Ciraolo, Sr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Elizabeth Dawn Vellajo
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MAR81AGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (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
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY. YEAR) (CITY/COUNTY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
Lo
-1
SUPPLEMENTAL FILE
FROM THE BRIDE
Kelly Lynn Sprague
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGECiraolo
(OPTIONAL - SEE REVERSE()96-74-1405
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A~Y BDutchess
(STATE) rJ.... (COUNTY)
C. CHECK ONE 0 CITY 'W TOWN 0 VILLAGE
~~cI~ougtiKeepSle
D. STREET ADDRESP "enton Koaa Zlpl :zti~;:S
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES f8 NO
13. A. AG~3 3B. DATE OF BIRTH 05 ;t2 )9 6
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATIOlireman Apprentice
B. TYPE OF IND~TRY Of! J3USINESS.USCG
15. PLACE OF BIRTHt-'ougnKeepsle, NY
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAMEThomas Edward Sprague
'B. COUNTRY OF BIRT~ S A
17. MOTHER
A. MAIDEN NAME Dorothy Lynn McCloskey
B. COUNTRY OF B;J.J S A
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DOORCE CIVIL A~ULMENT
D'[f TH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. '.~ YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEAR) ICITY/COUNTY. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
o 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
y knowledge and belief that the Information I provided is true and that I declare that no legal Impediment exists
22. SIGNATURE OF BRIDE~ _J/"().f.r:2;~ ).I1ArJJlt ~
~ ~CU~NA:.cr ~
DATE 05/04/2010
USEC
23. SUBSCRIBED AND SWORN TOI. F MED BEFORE ME
SIGNATURE OF TOWN OR C ERK ~
This license authorizes the marriage in New Y State of the bride and groom named above by any person authorized
Relations Law ~11to 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
} NAME (PRIN11 John C. Masterson
{ 10 ~ ~ ~
SEAL SIGNATURE ~. DATE 05/04/20
'- -J MA~~G~cfdf~ sh Rd, Wappingers Falls, NY 12590 AM 05 05 2010
-v- 03:56PM
STREET CITYrrOWN STATE ZIP
~~~R~~RT~~J IO~O~N~~E~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M. DA YEAR 0 0 RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
1ST
2ND
3RD
4TH
I duly swear/affirm, clep.ose and say, t tto
as to my right to enter Into the marn e st
SIGNATURE~
by New York Domestic
YEAR
07
03 201 0
IVIL
NAME (PRINT)
SIGNATURE~ ..