125
~~
...
z
W
rJl
W
'"
C
-'
::l
o
1:
rJl
Z
9
~
;j
.. :l
~
;';
~ ::l
... 0
5 '"'
~ 0
",,J:l
W,",a:
1:t\lW
~()~
~cn~
a: 0
g~ ~
<N ...
>- tlJ
u.. a:
:5 I-
... <Il
"-
rJ)
z:tz
"'...0
2~~
~~~
~~i
-'CJ~
rJl
u..
o
~~
w~~
...z....
o~z
Z-,_
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseph C.
FI RST MIDDLE
r
COONTY _ .Dutchess
~rrOWN Wappinger
~~~:k'iJ 13 6 8
~E~I~J~R 125
Rizzo
A. FULL NAME
CURRENT SURNAME
B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
o SDCIAL SECURITY NUMBER
2. RESIDENCE ANew Yo r k
(STATE)
=:J CITY ~ TOWN
Wappinger
D STREET ADDRESS 2D Scarborough Lane
C CHECK ONE
AND
SPECIFY
092-54-1395
B. Dutchess
, CCUNTY)
VILLAGE
ZIP 12590
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? =:J YES 00 NO
Sept. / 14 /1961
MONTH DAY YEAR
3. A. AGE
38
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Construction
B. TYPE OF INDUSTRY OR BUSINESS Local 29
5. PLACE OF BIRTH Brooklyn, New York
(CITY. STATEiCOUNTRY IF NOT USA)
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
Sam Rizzo
USA
Rosemarie Lange
A. MAIDEN NAME
B. COUNTRY OF BIRTH
USA
B. NUMBER OF THIS MARRIAGE
Second
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
B. HOW DID LAST MARRIAGE END? 31 Xi DIVORCE 31 _ ANNULMENT (2) 0 DEATH
C DATE LAST MARRIAGE ENDED? Sept. /25 /1995
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? X YES = NO
DEATH
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
9/25/95 Catskill. New York 0 ID
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
I
~ ~,.~l~
L C SUPPLEMENTAL FILE
~
t 1. A. FULL NAME
FROM THE BRIDE
Traci
FIRST
Endicott
CURRENT SURNAME
K.
MIDDLE
B. BIRTH NAME ,MAIDEN NAME). IF DIFFERENT
Rizzo
544-90-7662
B. Dutchess
, CCUNTY)
VILLAGE
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12 RESIDENCE~ New York
(STATE)
C. CHECK ONE C CITY ~ TOWN 0
~~~CIFY Wappinger
D. STREET ADDRESS 2D Scarborough Lane
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE' 0 YES X:; NO
13. A. AGE 32 13.B, DATE OF BIRTH March /25 / 1968
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Day Care
B. TYPE OF INDUSTRY OR BUSINESS Self-employed
15. PLACE OF BIRTH Eugene, Oregon
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
lB. NUMBER OF THIS MARRIAGE
Mark Endicott
USA
Janet K.
USA
First
Brooks
19. PREVIOUS lAARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVCRCE CIVil ANNULMENT
DEATH
B HOW DID '.AST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT
/ /
121 = DEATH
~. DATE cAST MARRIAGE ENDED?
YEAR
MONTH DAY
Q ARE .>.NY cORMER SPOUSE(S) ALIVE? 0 YES = NO
20. !F PREVICUSLY DIVORCED OR ANNUlED, PROVIDE THE FOllOWING INFORMATION
DATE CF DECREE PLACE ISSUED AGAINST WHOM
MONTH. JAY. YEAR) (CITY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
1, being duly sworn, depose and say, that 10 the
as 10 my right to enler inlo Ihe marria e slate.
1ST
=:J 2ND
[J w 3RD
o 0 4TH
t of my knowledge and belief Ihallhe tnformatlOn I provided is lru
23. SUBSCRIBED AND SWORN TO
SIGNATURE OF TOWN OR CITY
This license authorizes the marriage in New York tate of the bride and groom named above by any person authorized
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
Elaine Town Clerk
DATE 8/1/00
NY 12590
2' SIGNATURE OF GROOM ~
w
en
z
w
(.)
:J
~
{ SEAL }
'-.t-'
NAME (PRIN
SIGNATURE ~
MAILlNQ,ADDRE
PO HoX
STR ET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
S "-
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
1 ~CIVIl
w
~
(.)
u:
i=
a:
w
(.)
22. SIGNATURE OF BRIDE
..
Deputy Town Clerk
DATE Au!!;. 1, 2000
by New York Domestic
25. B. SOLEMNIZA nON PERIOD
ENDS AT MIONIGHT ON:
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
11 : 45AM
PM
8
2
00
9
30
00
Zl
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY .U,f7C't-;;.:E
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF C VilLAGE OF
SPECIFY EAs..,. /=tg II' k;L J
29. OFFICIANT
NAME (PRINT)
TITLEme."HlI~~~ ~PJ (
NAME (PRINT)
SIGNATURE ~
NAME (PRINT)
SIGNATURE ~