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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Steven M.
FIRST MIDDLE
1 ST :::J 1 ST ,~ :::J
2ND --, 2ND ~ :::J
3RD :::J 3RD r::::: 0
4TH ' , 4TH u :::J
I, being duly sworn, depose and say. that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the marriage state. f'l. .~I , L '/1 ~ _,
21. SIGNATURE OF GROOM ~ . /fIii(L 22. SIGNATURE OF BRIDE ~ V0 _l tf-~
USE CURRENT NAME
23 ~~J~T~~~OO~NT~~~ocf:6~Bg~~~~E Deputy Town Clerk OATESept. 6,2000
This license authorizes the marriage in ew 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.
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) ~ne H. Snowde~ Town Clerk
{SEAL SIGNATURE ~ ~ III t ~ SAl7l^~L... DATE 9/6/00 TIME MONTH DAY YEAR MONTH DAY
MAILING ADDRER~ AM
~ PO Box JL4, Wa in ers Falls NY 12590 1'45 09
STREET ITYIT WN STA E IP' . . PM
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 O~ RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED.
COUNTY
~:tVfTOWN
DISTRICT
NUMBER
REGISTER
NUMBER
Dutchess
Wappinger
1368
156
1. A. FULL NAME
MacDonald
CURRENT SURNAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 134-68-8029
D. SOCIAL SECURITY NUMBER
2. RESIDENCEA. N@w York B nl ~f"~r
(STATE) . (COUNTY)
C. CHECK ONE C CITY []{TOWN CJ VILLAGE
AND
SPECIFY Esopus
o STREET ADDRESS 30 Black Creek Rd. ZIP 12429
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? [] YES ~ NO
3. A. AGE 26 3B. DATE OF BIRTH Nov. / 29 /1973
MONTH DAY YEAR
4. EMPLOYMENT
A USUAL OCCUPATION Paramedic
B. TYPE OF INDUSTRY OR BUSINESS Mobil Life Support Ser
5. PLACE OF BIRTH Niskavuna. New York
(CITY. STA"fE/COUNTRY IF NOT USA)
6. FATHER
A. NAME James A. Mac Donald
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME SheilA. L Clappl'!r
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE First
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? 131 = DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) C DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES CJ NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATICN
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY. STATE COUNTRY. IF NOT USA) SELF SPOUSE
w
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I STATE FILE NUMBER I
(THIS SPACE FOR STATE USE ONL Y)
~ol4ov
Lo SUPPLEMENTAL FILE .-J
11, A. FULL NAME
FROM THE BRIDE
Carolyn L. Rossetti
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE l'1ac Donald
(OPTIONAL. SEE REVERSE) 6
D. SOCIAL SECURITY NUMBER 0 7-62-8090
12. RESIDENCEA. New York B. Dutchess
(STATE) I COUNTY)
C. CHECK ONE 0 CITY Jg TOWN !J VILLAGE
AND W .
SPECIFY appl.nger
D. STREET ADDRESS 17 Robert Lane ZIP 12590
E. IS RESIOENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES gJ NO
13.A. AGE 27 13.B.DATEOFBIRTH Mav /07 /1973
M'ONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Health Care Administrator
B. TYPE OF INDUSTRY OR BUSINESsN. Y. Medical Imaging
15. PLACE OF BIRTH Mt. Kisco. New York
_ (CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. N~E Francis P. Rossetti
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME HI'! 1 @n K. Hnn~y
B. COUNTRY OF BIRTH USA
1 B. NUMBER OF THIS MARRIAGE Fi r s t
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
(2):::J DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE ,31 = ANNULMENT
C. DATE LAST MARRIAGE ENDED? / /
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. IF NOT USA) SELF SPOUSE
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
YEAR
07
00
05
00
11
9 D OTHER. SPECIFY
1 = CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. ~
:3 PM
""'m~ ..J! U' ~"7/
NAME (PRINT) '17 7'V- / I,~ ,.
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/~C:JWAGi:.ro-;i)<< /bf <-
STREET CITY,TOWN
30. WITNESS TO CEREMONY
NAME (PRINT) ,8 I( A 0
SIGNATURE~ ~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF ~WN OF 0 VILLAGE OF
SPECIFY~/ ~
TITLE ~ c.- I1k I e,f)
DATE 9 /Jd /;...-..;
h.r 4/(, /J' A./( /J.-f2.-Y
I ZIP
31. WITNESS TO CEREMONY 7\
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SIGNATURE~ - ~ ~'V-
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STATE