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COUNTY
~1YfTOWN
DISTRICT
NUMBER
REGISTER
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Thomas o.
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
Dutchess
Wappinger
1368
170
~
L ::::J SUPPLEMENTAL FILE
FROM THE BRIDE
Christina 1.
Pisaturo
CURRENT SuRNAME
A FUll NAME
Paonessa, Jr. 11~. FULLNAME
CURRENT SURNAME
FIRST
MIDDLE
FIRST
MIDDLE
"-
N
B BIRTH NAME .MAIDEN NAME), IF DIFFERENT
v. SURNAME ~FTER MARRIAGE
,OPTIONAL - SEE REVERSE)
Q SOCIAL SECURITY NUMBER
12 RESiDENCEA New York
,STATEI
C CHECK CNE 0 CITY ~ TOWN
~~by Beekman
D STREET ADDRESS 5604 Chelsea Cove Dr. N ZIP
Hopewell Junc~~on
" :s RESIDENCE 'NITHIN LIMITS OF CITY Q'I:lINCORPORA TED VilLAGE? c::
13, A. AGE 22 13,B, DATE OF BIRTH Nov. / 7
YES X:: NO
/ 1977
YEAR
8 BIRTH NAME, IF DIFFERENT
Paonessa
109-66-0092
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE I
D SDCIAl SECURITY NUMBER
2, RESIDENCE A, New York
ISTATE:
= CITY = TOWN ::X VilLAGE
Wappingers Falls
o STREET ADDRESS 35 So. Mesier Ave.
090'-50-6954
B, Dutchess
,COUNTY)
Dutchess
,COUNTYI
VilLAGE
B
0, CHECK ONE
AND
SPECIFY
12590
12533
ZIP
3. A. AGE
36
July
MONTH
14. EMPLOYMENT
MONTH
DAY
38. DATE OF BIRTH
DAY
4 EMPLOYMENT
A, USUAL OCCUPATION Bank Supervisor
B. TYPE OF INDUSTRY OR BUSINESS Hudson United Bank
15, PLACE OF BIRTH Bronx. New York
(CITY, STATE/COUNTRY IF NOT USA)
A. USUAL OCCUPATION Correction Officer
B. TYPE OF INDUSTRY OR BUSINESS D. C. Sheriff's Office
5. PLACE OF BIRTH Poughkeepsie, New York
,CITY, STATE. COUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17, MOTHER
~. MAIDEN NAME
3. COUNTRY OF BIRTH
Jady Daniluk
Germany
First
6. FATHER
Leslie Pisaturo
Canada
A, NAME Thomas Paonessa, Sr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Edith DiMarco
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE
First
1 B. ~UMBER OF THIS MARRIAGE
19, ?"lEVIOUS MARRIAGES
A. NUMBER CF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
9, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
JEATH
DEATH
(21 = DEATH
2 = JE,~7;"
B HOW DID LAST MARRIAGE END? ,31 = DIVORCE 13) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
o ARE ANY FORMER SPOUSE,S) ALIVE' = YES :J NO
3. "OW DID LAS7 'AARRIAGE END? (3) c:: DIVORCE 31 = ANNULMENT
" :CATE LAS7 \\ARRIAGE ENDED? / /
MONTH DAY vE~?
_ -,RE ANY ,CRMER SPOUSEIS) ALIVE? = YES = NO
20 F =qEVIOUSLY DIVORCED OR ANNUlED. PROVIDE THE FOllOWING lNFCRMATiCN
JATE OF JEGREE PLACE ISSUED AGAil<S7 Wf,CM
MONTH, DAY. YEAR) (CITY, STATEiCOUNTRY. IF NOT USAi SEe' SPOUSE
10 IF PREVIOUSLY DIVORCED OR ANNUlED. PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
,MONTH. DAY, YEARI (CITY, STATE COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I. being duly sworn, depose and say, that
as to my right to enter into the marria
~ '--' 1ST
2ND
c- 3RD
21 SIGNATURE OF GROOM ~
w
en
z
w
()
:::i
4TH
age and belief that the nrormatlon I prOVided IS true and that I declare that no legal Impeclment eXls:s
f) h .::. r ,-';:> (' ? ~" ~, r.
22 S,GNATURE CF SRIDE ~', ) ! ,LA, llt \\_v~ V .\..:l . U ~ i:.
" . - USE CURRENT NAME
23 Deput Town Clerk DATE Sept. 14, 200
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.
If checked. this license is to be used only for the purpose of a second or subsequent ceremony.
ClER~ H 25. A. SOLEMNIZATION PERIOD BEGINS
~ne . Town Clerk
DATE 9/14/00
NY 12590
STATE
27. TYPE OF CEREMONY
o c:Y'AE~IGIOUS
24. TOWN OR
25. 8, SOLEMNIZATION PERIOD
ENDS AT \,lIDNIGHT ON
~
{ SEAL}
'-.,-I
NAME ,PRINT)
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
SIGNATURE F
MAILING ADORES
PO Box 324.
STREE7
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
AM
3:00 PM
00
9
15
00
11
13
Wappingers Falls.
CITY TOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
ZIP
28. PLACE WHERE MARRIAGE OCCUR::J>.
A. STATE NEW YORK B OOUN ~d'r/f!"S!.
CIVil
9 0 OTHER, SPECiFY
C lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~:LAGE OF
SPECIFY W~/~~5 f/rus
SIGNATURE ~
SIGNATURE ~