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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
23. SUBSCRIBED AND SWORN
SIGNATURE OF TOWN OR CI 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 ~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) John C. Masterson
{TIME MONTH YEAR MONTH
SEAL SIGNATURE~ DATE 08/11/201
"-- -.J MAIl,ltJ.(l "DJ)IR,E~:;eb AM
-yo- LU MIOOII h Rd, Wappingers Falls, NY 12590 12:09:>M 08 12 2010 10 10 2010
STREET CITYrrOWN STATE ZIP
~~~R~~~RT~~~ 10~O~~~N~Zi~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY . ~
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 ~VIL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER. SPECIFY
COUNTY Dutchess
CITYfTOWN Wappinqer
~~~~~: 1368 .
~~~~~~R 1 03
1 . A. FULL NAME
John Joseph CennamerJ SR
MIDDLE CURRE T SURNAME
FIRST
c.
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 123 58 8132
D. SOCiAl SECURITY NUMBER --
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY!i'1 TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D. STREET ADDRESS 8 Montfort Woods Rd
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES ~ NO
3. A. AGE 45 3B. DATE OF BiRTH 0' / 26 / 1 965
MONTH DAY YEAR
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4. EMPLOYMENT
A. USUAL OCCUPATION Police Officer
B. TYPE OF INDUSTRY OR BUSINESS Law Enforcement
5. PLACE OF BIRTH Bridoeport, Connecticut
(CITY. S~TE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Fr~nk C~rl Cenname
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Diane Catherine Brooker
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
(3
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) cYDIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 05/ 12 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 0 NO
10. 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
05/12/2008 Poughkeepsie, Ny d
DEATH
o
(2) 0 DEATH
2008 .
YEAR
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1ST
2ND
3RD
4TH
I duly swear/affirm, depose and
as to my right to enter into
o
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21. SIGNATURE OF GROOM
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STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
"I
L 0 SUPPLEMENTAL FILE
~
FROM THE BRIDE
Deborah Ann Conforti
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Lem me
c. SURNAME AFTER MARRIAGE Cenname
(OPTIONAL - SEE REVERSE) 125 62 2859
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Wappinaer
D. STREET ADDRESS 8 Montfort Woods Rd ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES d NO
02 /19 /1964
MONTH DAY YEAR
11. A. FULL NAME
13. A. AGE 46
13B.DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Waitress
B. TYPE OF INDUSTRY OR BUSINESS Hospitality
15. PLACE OF BIRTH Yonkers. New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Roger Douglas Lemme
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Maureen Ann Troy
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 3
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
DEATH
1
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) dDEATH
C. DATE LAST MARRIAGE ENDED? 03 / 20 / 1997
MONTH ~AY ~ YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES D 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
07/30/1985 Mineola, Ny d"
1ST
2ND
3RD
4TH
t the information I provided is t
o
o
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~Tt,~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LAGE OF.. 11.
SPECIFY W*A';;t:b~ ~
NAM
SIGNATURE~
....