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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Paolo Capparelli
MIDDLE CURRENT SURNAME
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I duly swe!lr/afflrm, aep'Dse and say,thatto the best of my knowledge and belief that the Information I provided is Cilrue d that I declare t~hat n~legal imp'diment exists
as to my nghtto enter Into the marriage st e.
21. SIGNATURE OF GROOM~ 22. SIGNATURE OF BRIDE~ ItL,o(;\ QAl ")
NT AME USE CURR NAME
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEF R ME 06/09/2010
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
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 ~11to 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 urpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) Jo C. Maste on
TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ DATE
MAILING ADDRE~S 11:48 AM 06 10 2010 08 08 2010
'-v-' 20 Middleb PM
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
couNTYDutchess
CITY/TOWN Waooinaer
~~J~~c;1368
REGISTERt:-2
NUMBER 0
1 . A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE~
D. SOCIAL SECURITY NUMBER ,,19-72-3891
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 crrW!J TOWN 0 VILLAGE
AND W .
SPECIFY appmger
D. STREET ADDRESS 25 Kent Rd ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YEt'D NO
08 /22 /1985
MONTH DAY YEAR
3. A. AGE?4
3B. DATE OF BIRTH
to-
=>
4. EMPLOYMENT
A. USUAL OCCUPATION Police Officer
B. TYPE OF INDUSTRY OR BUSINESS Law Enforcement
5. PLACE OF BIRTHPouihkeepsie. Nv
(CITY, TATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME LJmberto Albert Capparelli
B. COUNTRY OF BIRTH Italy
7. MOTHER
A. MAIDEN NAME Gina Romeo
B. COUNTRY OF BIRTH Italy
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
C. DATE LAST MARRIAGE ENDED?
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
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I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Andrea Grace Lumia
-.J
11. A. FUll NAME
FIRST
MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAG~apparelli
(OPTIONAL - SEE REVERS960-74-8640
D. SOCIAL SECURITY NUMBER
12. RESIDENCE.NY putchess
(STATE) J. (COUNTY)
C. CHECK ONE 0 CITY" 0 TOWN 0 VilLAGE
AND 'AI .
SPECIF't" ~ applnger
D. STREET ADDRE~5 Kent Kd ZIJ 2590
II
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
13. A. AG~5 3B. DATE OF BIRTH 05 ~ }S 5
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATIONT eacher
B. TYPE OF INDUSTRY OR BUSINES~ducatlon
15. PLACE OF BIRT~oughkeepsle, Ny
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAM~ohn Charles Lumia
'B. COUNTRY OF BIRT~taly
17. MOTHER
A. MAIDEN NAMEMarcia Jean Gilland
B. COUNTRY OF BIRT~ S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DOORCE CIVIL ABNULMENT
D{fTH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. ,- YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
YEAR
10 CIVIL
26. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY '?l...l+,JA ,.
LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)