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COUNTY
."rrOWN
DISTRICT..
NUMBER
REGISTER
NUMBER
ST A TE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Robert W.
FIRST MIDDLE
Dutchess
Wappinger
1368
116
1. A. FULL NAME
Saglibene
CURRENT SURNAME
11. A. FULL NAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
/1'\\ \ o"b
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Christine Ellen
FIRST MIDDLE
~
Cromer
CURRENT SURNAME
069-62-5750
B. Dutchess
(COUNTY)
VilLAGE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York
(STATE)
o CITY ~ TOWN 0
Wappinger
11 Sabra Lane
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER
2. RESIDENCE A. New Yo r k
(STATE)
c. CHECK ONE 0 CITY ~ TOWN 0
~~~CIFY Union Vale
D. STREET ADDRESS North Parliman Road
La{;ran2ev~l.Le
E. IS RESIDENCE WITHIN UMITS OF CITY OR INC~PORATED VILLAGE?
3. A. AGE 26 3B. DATE OF BIRTH Nov. /
MONTH
C, CHECK ONE
AND
SPECIFY
ZIP 12540
DYES~NO
7 / 1973
YEAR
DAY
14. EMPLOYMENT
4. EMPLOYMENT
Saglibene
053-66-4311
Dutchess
(COUNTY)
VilLAGE
B.
A. USUAL OCCUPATION Student
B. TYPE OF INDUSTRY OR BUSINESS Dutchess Comm. College
5. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATEiCOUNTRY IF NOT USA)
A. USUAL OCCUPATION Music Teacher
B. TYPE OF INDUSTRY OR BUSINESS Take Note Music Studio
15. PLACE OF BIRTH Poughkeepsie. New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Kenneth Saglibene
USA
Catherine
Canada
First
Wade
Donald Cromer
USA
Mary Barbara
USA
First
Wehrle
8. NUMBER OF THIS MARRIAGE
18. NUMBER OF THIS MARRIAGE
DEATH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
DEATH
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
B. HOW DID LAST MARRIAGE END? (310 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
1 D. 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
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES :J 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
1ST 0 C 1ST C
2ND 0 0 2ND [J C
3RD 0 0 3RD 0 :::
~ 0 0 ~ ~ ~
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the mama state. 7/J - Ii) /I A
21. SIGNATURE OF GROOM. 22.SIGNATlUREOFBRIDE. ('~-!,:I~ (. ~
_ USE CURRENT NAME
Deputy Town Clerk July 24 2000
DATE '
This license authorizes the marriage in New York tate 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 onl for the U of a second or subs uent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
Elaine H. Snowden, Town Clerk
23.
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{ SEAL }
'-v-I
NAME (PRINT)
DATE 7/24/00
NY 12590
24, Wappingers Falls,
I
26. SOLEMNIZATION OCCURRED
1M. Y Y
A
27. TYPE OF CEREMONY
o ~ELlGIOUS
9 0 OTHER, SPECIFY
I CERTIFY THAT I SOLlEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
25. B. SOLEMNIZA T10N PERIOD
ENDS AT MIDNIGHT ON:
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
11 :45 AM
PM
00
9
22
00
7
25
1:J CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY f).ItcfJ!."i'5
C. LOCATION OF CEREMONY
(CHECK ONE ANI} SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY lMf hshtll/
1 ,1 ~
TITLE ~fflt),n t....:A.rhcllC" r
DATE 75J 5/ ~($X9(/
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