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1. A FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Genaro A. Lomoriello
FIRST MIDDLE CURRENT SURNAME
I
(THIS SPACE FOR STATE USE ONL Y)
i;J1"1~ ..-,..... ...-....--..
Dutchess
-Wappinger
1368
190
.J
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Eileen M.
FIRST MIDDLE
Markett
CURRENT SURNAME
11. A. FULL NAME
B BIRTH NAME. 'F DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SDCIAL SECURITY NUMBER
12. RESIDENCE A. New York
(STATE)
C. CHECK ONE 0 CITY ~ TOWN 0
~~~CIFY poughkeepsie
D STREET ADDRESS 18 E. Dogwood Drive
ZIP
12601
2. RESIDENCE A.
073-62-6517
B. Dutchess
(COUNTY)
VILLAGE
068-70-8261
B. Dutchess
(COUNTY)
VILLAGE
3. A. AGE
33
Dec.
MONTH
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? - YES x: NO
13.A. AGE 29 13.B.DATEOFBIRTH Oct. /30 /1970
MONTH DAY YEAR
3B. DATE OF BIRTH
14. EMPLOYMENT
4. EMPLOYMENT
A. USUAL OCCUPATION Economic Development
B. TYPE OF INDUSTRY OR BUSINESS D. C. Economic Corp.
15. PLACE OF BIRTH poughkeepsie, New York
(CITY, STATE/COUNTRY IF NOT USA)
A. USUAL OCCUPATION Public Relations
B. TYPE OF INDUSTRY OR BUSINESS Consumers Union
5. PLACE OF BIRTH poughkeepsie, New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
John J. Markett
USA
6. FATHER
A NAME
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Genaro F. Lomoriello
USA
Mary B. Marmion
Northern Ireland
First
Eleanor Moschetto
USA
First
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? (3) =:] DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
2! = DEATH
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, STATEiCOUNTRY, IF NOT USA) SELF SPOUSE
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? eYES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY. YEAR) (CITY. STATEiCOUNTRY. IF NOT USA) SELF SPOUSE
21.
1ST
2ND
3RD
4TH
I, being duly sworn, depose and S
as to my right to enter into the m
o
o
"
c..J
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en
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. formation I provided is true and that I declare that no legal Impediment eXists
22. SIGNATURE OF BRIDE ~ %!;~ IPr jf/?,,+IL.'7'"f
. USE CURR~E "6-
23. Deputy Town Clerk DATE Sept. 28, 2000
This license authoriz the marriage in New York Sta of the bride and groom named above by any person authorized by New York Domestic
Relations Law 911 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
} NAME (PRINT~ Elaine ~en, Town Clerk
{ S EAL ,~'''"'' .t::90 "" \\ ~ ",,,,,oci.. _ "",,9/28/00 "M' MaN," "" 'eA' Me,," "" 'eA'
'-v-' MtlJQNGJtg~REj~4, Wappingers Falls, NY 12590 2'. 45 :~ 9 29 00
STREET CITYITOWN STATE ZIP
~~~R~~Ri~~~ 'O~O~~~N~EE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M DAY YEAR 0 IX RELIGIOUS 10 CIVIL
DATE AND AT THE TIME AND AM
PLACE INDICATED 1: 00 PM 00 90 OTHER, SPECIFY
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
11
27
00
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY Dutchess
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
29. OFFICIANT
NAME (PRINT) Rev. JOSePh~
"""''"'' .~ ~
MAILING ADDR
775 Ma reet. Poughkeepsie. NY
STREET CITYITOWN
30. WITNESS TO CEREMONY
Prie!;t
o CITY OF XJ TOWN OF 0 VILLAGE OF
SPECIFY Pou~hkeepsie, NY
TITLE
DATE
October 28, 2000
12603
STATE
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE ~
DOH-98 (1198)
NAME (PRINT)
SIGNATURE ~