194
.r STATE OF NEW YORK I STATE FILE NUMBER I
(THIS SPACE FOR STATE USE ONLY)
COUNTY Dutchess DEPARTMENT OF HEALTH
~ITOWN Wappinger AFFIDAVIT, LICENSE and
DISTRICT 1368
NUMBER
REGISTER 194 CERTIFICATE OF
NUMBER
MARRIAGE Lo SUPPLEMENTAL FILE .-J
FROM THE GROOM FROM THE BRIDE
1. A FULL NAME Stephen M. DeMelio 11. A. FULL NAME Jennifer DelValle
FIRST MIDDLE CURRENT SURNAME FIRST MIDDLE CURRENT SURNAME
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B BIRTH NAME. IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE DeMelio
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER 065-72-2670
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY}{] TOWN 0 VILLAGE
AND
SPECIFY Poughkeeps ie
O.STREETAODRESS 6F Hudson Hrbr. ZIP 12601
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE' 0 YES:8I NO
13.A. AGE 24 13.B.DATEOFBIRTH Aup-. /01) /lq76
MOIilTH DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER
2. RESIDENCEA. New York
(STATE I
C. CHECK ONE = CITY ~ TOWN 0
AND
SPECIFY poughkeeps ie
D. STREET ADDRESS 6F Hudson Hrbr. Dr.
094-72-0330
B. Dutchess
(COUNTY)
VILLAGE
ZIP
12601
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES IE NO
3. A. AGE 28 3B. DATE OF BIRTH MR.V / 08 /1 q72
MONTH DAY YEAR
14. EMPLOYMENT
4. EMPLOYMENT
A. USUAL OCCUPATION Photographer
B. TYPE OF INDUSTRY OR BUSINESS peA Stun; os
15. PLACE OF BIRTH Bronx ~ New York
(CITY, STATElC UNTRY IF NOT USA)
A. USUAL OCCUPATION Manalier
B. TYPE OF INDUSTRY OR BUSINESS Pri ce Chopp~r
5. PLACEOFBIRTH Nanuet. New York
(CITY. STATElCOUNTRY IF NOT USA)
16. FATHER
6. FATHER
A. NAME Joseph DelValle
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Rita Ann Goldstein
B. COUNTRY OF BIRTH nSA
18. NUMBER OF THIS MARRIAGE F; r l': t
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
A. NAME Richard James DeMelio
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Sally Ann Aponte
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE Fi rl': t
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) C 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 ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) ,-CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
B. HOW DID LAST MARRIAGE END' (3) 0 DIVORCE (3) 0 ANNULMENT (2\ C DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE' 0 YES == 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
c
1ST
2ND
3RD
4TH
I, being duly SWDrn, depose and sa
as tD my right to enter intD the ma .
21. SIGNATURE OF GROOM ~
1ST
2ND
3RD
4TH
nd belief that the information I provided is tr
=
DATE 1 n In? I ?nnn
by New York Domestic
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23. SUBSCRIBED AND SWORN TO B
SIGNATURE OF TOWN OR CITY ERK ~
This license authorizes the marriage in New York State of the b de and groom named above by a rson aut orized
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
Elaine Town Clerk
DATE 10/02/00
NY 12590 11: 45AM 10
STATE ZIP PM
, 27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
DrfT'Cieo
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
~
{ SEAL }
'-.,-I
NAME IPRINT)
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
03
00
12
01
00
SIGNATURE ~
Mlltr'1f8~RE
STREET
I CERTIFY THAT 1 SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
4. Wappingers Falls,
CITY !TOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEA
3~
r::><:1
28. PLACE WHERE MARRIAGE OCCURRED
1 Gl-"tIVIL
A. STATE NEW YORK B. COUNTY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF GAf1LLAGE OF
" 0"'''''' ~ 1!1f:::11. ~
NAME (PRINT) 5 d. 0 (.
SIGNATURE ~ !/'. fit
MAILING ADDRESS
:J I h) ((' Mf-e lr'l It.. wAPI/lJ6elJ IAU j
STREET ' CITYITOWN
30. WITNESS TO CEREMONY
TU5rIC./l
DATE 1//1/t> fI
Al. Y
STATE
SPECIFY (~JAPlI~/elS .(2Au>
I
AJ'f
TITLE
NAME (PRINT)
SIGNATURE ~
NAME (PRINT)
SIGNATURE ~