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Dutchess
Wappinger
1368
154
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
E.
MIDDLE
I STATE FILE NUMBER I
(THIS SPACE: FOR STATE: USE: ONLY)
/ lull~lof)
Lo SUPPLEMENTAL FILE ~
1. A. FULL NAME
Darren
FIRST
Bocchino
CURRENT SURNAME
11. A. FUll NAME
FROM THE BRIDE
Joanne Pettit
FIRST MIDDLE CURRENT SURNAME
8 BIRTH NAME. IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Tripputi
c. SURNAME AFTER MARRIAGE Bocchino
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 127 - 5 0- 9 4 61
12. RESIDENCE A. New York B Dutchess
(STATE) . (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VilLAGE
~~~CIFY East Fishkill
12603 0 STREETADDRESS 25 Prentiss Dr. ZIP 12533
YES cJC NO E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES 1J NO
/1962 13.A.AGE 44 13.B.DATEOFBIRTH July /03 /1956
YEAR MONTH DAY YEAR
3. A. AGE
38
July
MONTH
14. EMPLOYMENT
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Medical Assistant
B. TYPE OF INDUSTRY OR BUSINESS New Century Medical Ass(
15. PLACE OF BIRTH Brooklyn. New York
(CITY, STATE/COUNTRY IF NOT USA)
A. USUAL OCCUPATION Minister
B. TYPE OF INDUSTRY OR BUSINESS Unemployed
5. PLACE OF BIRTH Poughkeepsie. New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
6. FATHER
A. NAME
John
C. Bocchino
USA
A. NAME Patrick R. Tripputi
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Janet Lavoro
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE Second
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
One
DEATH
B. COUNTRY OF BIRTH
7. MOTHER
MiUer
Linda J.
USA
8. NUMBER OFTHIS MARRIAGE Firs t
A. MAIDEN NAME
B. COUNTRY OF BIRTH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? (3) U DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3)~ DIVORCE ,3) = ANNULMENT 2'-' DEATH
C. DATE LAST MARRIAGE ENDED? June /24 / 1998
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
6/24/98 Dutchess Co. New York ~
YEAR
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? eYES 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
1ST
2ND
3RD
4TH
I, being duly sworn, depose an
as to my right to enter into the
21. SIGNATURE OF GROOM......
o C 1ST
o _ 2ND 0
o -' 3RD 0
o UH ' 0
. ' that the best of my knowledge and belief that the Information I provided is trul-'\nd that I declare that no legal impediment exists
nage st te. I ) I:J .- I.' It
. . ATUR FBRIDE~ _/Otl.r1M I~
(,.,/ USE CURRENT NAME
Town Clerk DATE Sept. 5.2000
w
en
z
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o
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23. SUBSCRIBED AND SWORN TO ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York ie
Relations Law ~11 to perform marriage ceremonies within New rk SI HIS LICENSE ALlD IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for tli a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)~aine 1M- ~ ....Iown CleI:k
SEAL SIGNATURE~~flL~ W ~~/1-. DATE q/"i/OO
MAILING ADDRESS
'-.,-I PO Box 324 Wa in ers Falls
STREET CITYrroWN
~~~R~~~Ri~~~ 10~0~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR
DATE AND AT THE TIME AND J AM /
PLACE INDICATED d,e":,,O 00
11
04
00
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
10:00M
PM
09
06
00
ZIP
TATE
27. TYPE OF CEREMONY
o tit RELIGIOUS
9 0 OTHER, SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY ~1-/6!'1
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~TOWN OF 0 VilLAGE OF
SPECIFY 110 1'&W'j::J,..I.-.. JV4C T1~ r/
J: A- ST FmtK (/..J.
29. OFFICIANT ~~~~:~ . "J.
NAME (PRINT) I _ (X/oCL',.;/
SIGNATURE~~ _ --- ~~
MAILING ADDRESS I . /I
, D .vi!- 'V't 0 "I~I&--
STREET CITYfTOWN
30. WITNESS TO CER~MONY
NAME (PRINT) ftLL. E..,..s A- L 111-0 u...S t
SIGNATURE~ ~ ~
OOH-98 (1198)
TITLE /'1/rV/S7G,t..
/0 II'" /0(,)
, ,
tV. /~
STA E
DATE
NAME (PRINT)
SIGNATURE ~