147
I STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL V)
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L i" SUPPLEMENTAL FILE ~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
James Vincent
Dutchess
Wappinger
1368
147
COUNTY
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DISTRICT
NUMBER
REGISTER
NUMBER
FROM THE BRIDE
Lynne A.
FIRST MIDDLE
Miele
CURRENT SURNAME
CrUo
CURRENT SURNAME
11. A. FULL NAME
1. A FULL NAME
MIDDLE
Fd:~S,
B. BIRTH NAME (MAIDEN NAME:. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERse,
o SOCIAL SECURITY NUMBER
12 RESIDENCE A New York
(STATE)
C CITY X TOWN :=
Wappinger
o STREET ADDRESS 37 Wildwood Drive
Miele-CrUo
102-68-5033
Dutchess
,COUNTYI
VILLAGE
"-
N
BIRTH NAME. IF DIF;,,?ENT
"-'
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE ~EVERSEI 078 5 2 0363
D SOCIAL SECURITY 'IUI.IBER - -
2. RESIDENCE.~ NeTN York B. Dutchess
,STATE (COUNTY)
C. CHECK ONE = CITY X TOWN VILLAGE
~~~CIFY Eas t Fishkill
o STREET ADDRESS 11 Briarhill Road ZIP 12533
E is RESIDENCE WITH'N .MITS OF~~O~~~O~~RA~E~u~~~on C
3. A. AGE 35 3B. DATE OF BiRTH March / 10
B
C CHECK ONE
AND
SPEC:FY
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE' U YES X NO
13.AAGE 29 13.B.DATEOFBIRTH April/23 ~971
MONTH DAY YEAR
YES :X NO
/ 1965
YEAR
DAY
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Customer Service Rep
B. TYPE OF iNDUSTRY OR BUSINESS NY Medical Imaging
15. PLACE OF BIRTH Lake Carmel, New York
(CITY. STATE COUNTRY IF NOT USAI
4. EMPLOYMENT
A. USUAL OCCUPATION Elec trician
B TYPE OF INDUSTRY OR BUSiNESS IBEW LU 363
5. PLACEOFBIRTH Beacon, New York
C:TI. STATE COUNTRY IF NOT USA)
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16. FATHER
A. NAME
B COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Pasquale Miele
USA
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
A MAIDEN NAME
B. COUNTRY OF BIR"H
James CrUo
USA
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Ann LeBrando
USA
First
Elsie Marrone
USA
Second
18. NUMBER OF THIS MARRIAGE
8. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRiAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
9. PREVIOUS MARRiAGES
A. NUMBER OF PRE'/IOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
DEATH
DEATH
2) = OE.~-:-'~
31 = ANNULMENT
/ /
(3\ C DIVORCE
B. HOW DID LAST MARRIAGE "NO'
B. HOW DID LAST MARf'IAGE "NO' 31 :x DIVORCE 13) C ANNULMENT (2\ ~ DEUH
C. DATE LAST MARRiAGE ENDED? April / 27 / 1992
MONTH DAY YEAR
D. ARE ANY FORME::; SPOUSE,S) ALIVE' X YES = 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
4/27/92 Poughkeepsie, NY ~
C. DATE :.AST MARRIAGE ENDED?
YEAR
MONTH :lAY
J. ARE ~NY FORMER SPOUSE,S) ALIVE? = YES = NO
20. :F PREVIOUSLY DIVORCED OR ANNULED. PROVIDE "HE FOLLOWING INFORMATICN
DATE OF DECREE PLACE ISSUED AGAINST WHOM
,MONTH DAY. YEAR) .CITY. STATE/COUNTRY. IF 'lOT USA'> SELF SPOUSE
'--
1ST
2ND
3RD
4TH
and belief that the Information I provided is true
Aug. 25. 2000
DATE
23 SUBSCRIBED AND SWCRN TO BEFO,Il
SIGNATURE OF TOWN C:R CITY Clcfll
This license authOrizes the riage in New York tate of the bride and groom named above by any person authorized
Relations Law 911 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
- 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) . Elaine Town Clerk
SIGNATURE ~ ~ L. ^ DATE 8/25/00
MAILING ADDRESS AM
PO Box 324, Wappingers Falls. NY 12590 2:00 PM
STRE"" CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMMZED 26 SOLEMNIZATION OCCURRED 27;ZTYP OF CEREMONY
THE MARRIAGE OF THE "ER.
SONS NAMED ABOVE 0'" 7~E TIME MO. DAY YEAR 0' RELIGIOUS
DATE AND AT THE TIME 'ND 5,.
PLACE INDlCATED.DC ~ OTHER. SPECIFY
by New York Domestic
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25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON'
~
{ SEAL }
'-,-I
YEAR
DAY
MONTH
YEAR
DAY
MONTH
TIME
00
24
10
00
26
8
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYj)uf'~~ S
CIVIL
C. LOCATION OF CEREMONY
(CHECK ONE AND)pECIFY)
= CITY OF ~OWN OF C VILLAGE OF
SPECIFY fbv<;;it ~p:;., II;
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29. OFFICIANT
NAME (PRINT)
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ZIP
31 WITNESS TO CEREMONY
NAME (PRINT) ~ i b '\,
SIGNATURE ~