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COUNTY
~~fTOWN
DIS'rRICT
NUMBER
REGISTER
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Jamie B.
I STATE FILE NUMBER -\
(THIS SPACE FOR STATE USE ONLY)
~/ol'-J/-/DV
Lo SUPPLEMENTAL FILE ~
Dutchess
Wappinger
1368
160
CURRENT SURNAME
FROM THE BRIDE
Kristy 1.
FIRST MIDDLE
Notarangelo
CURRENT SURNAME
Weiss
11. A. FULL NAME
1. A. FULL NAME
MIDDLE
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
o SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York
(STATE) 'L
C. CHECK ONE 0 CITY ~ TOWN C VILLAGE
~~~CIFY poughkeepsie
o STREET ADDRESS 2 Dakin Road ZIP 12590
E. IS RESIDENCE WITHIN L1MI~~pgJ~~~6R~J:D~~~GE? 0 YES ~ NO
13. A. AGE 25 13.B. DATE OF BIRTH J an. / 21 / 1975
MONTH DAY YEAR
B BIRTH NAME. IF DIFFERENT
Weiss
096-62-4084
B Dutchess
iCOUNTY)
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
o SOCIAL SECURITY NUMBER
New York
(STATE)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Eas t Fishkill
o STREET ADDRESS 57 S 1 van Lake Ro ad
onewe unctl.on
E. IS RESIDENCE WITHiN L1MI S OI"CITY OR INCORPORATED VILLAGE? 0
3. A. AGE 26 3B DATE OF BIRTH Aug. / 27
MONTH DAY
2. RESIDENCE A.
117-54-7553
B. Dutchess
(COUNTY)
ZIP 12533
YES ~ NO
/1974
YEAR
14. EMPLOYMENT
4. EMPLOYMENT
A. USUAL OCCUPATION Social Worker
B. TYPE OF INDUSTRY OR BUSINESsNew York Presbyterian
. k HospiLal
15.PLACEOFBIRTHMt. Kl.sco. New Yor
(CITY, STATEJCOUNTRY iF NOT USA)
A. USUAL OCCUPATION Accountant
B. TYPE OF INDUSTRY OR BUSINESS PricewaterhouseCoopers
5. PLACEOFBIRTH Bronx. New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Thomas Notarangelo
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME
6, FATHER
A, NAME
B. COUNTRY OF BIRTH
7. MOTHER
Stanley Weiss
USA
Wasserlauf
Susan Novak
USA
First
Barbara
USA
8. NUMBER OF THIS MARRIAGE Fir s t
A. MAIDEN NAME
B. COUNTRY OF BIRTH
B. COUNTRY OF BIRTH.
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
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) C DEATH
B. HOW DID LAST MARRIAGE END? (31 C DIVORCE
C. DATE LAST MARRIAGE ENDED?
,31 = ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? = 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, !F NOT USA) SELF SPOUSE
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
[1
1ST
2ND
3RD
4TH
I, being duly sworn, depose and say. th to the best of my kno
as to my right to enter into the marria state.
o 1ST
o 2ND
[1 3RD
4TH
ge and belief that the information I provided is true and that I dec
,.....
L-
c
21
W
(/)
Z
W
u
::::i
~ 22. SIGNATURE OF BRIDE ~
ENTNA i ~
23. SUBSCRIBED AND SWORN TO .l Deputy Town
SIGNATURE OF TOWN OR CI . .",- A.i /' .(" L..-
This license authorizes the marriage in New York St te of the bride and groom named above by any person authorized
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
{ } NAME (PRIN~aine H. Snowden. Town Clerk TIME MONTH DAY YEAR
SEAL SIGNATURE~f:aaI.(.u..~ ~H~_ DATE 9/8/00
MAILING ADDR~!iS AM
~ PO Box Jl4, Wappingers Falls. NY 12590 1'.00 PM 9 9 00
STREET CITYITOWN TATE ZIP
I CERTIFY THAT I SOLEMNIZED 26, SOLEMNIZATION OCCURRED 27~TYPE OF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 RELIGIOUS 10 CIVIL
DATE AND AT THE TIME AND f. '"
PLACE INDICATED 0 (?(f ~ 90 OTHER, SPECIFY
P 6EUEw
11
7
00
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
DAY
YEAR
29. OFFICIANT
NAME (PRINT)
f, C: jJ~/:E>I
/0/.5l1/ ~C'dtJ
. . I~ 5"""1tJ
28, PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN.::!J.trc/((;:>$
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY '" C "'W' '" .ni: 0'
SPECIFY W f}ff'lNM:12.> tflut;.
TITLE
SIGNATURE ~