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1. A FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Lawrence A.
FIRST MIDDLE
I (THIS SPACE FOR STATE USE UNLT)
/ cA\\\OD
L 0 SUPPLEMENTAL FILE ~
Dutchess
Wappinger
1368
106
FROM THE BRIDE
Jennifer A.
FIRST MIDDLE
Dayger
CURRENT SURNAME
Racioppo
CURRENT SURNAME
11. A. FULL NAME
12. RESIDENCEA.
RaciopPo
058-56-2515
B. Dutchess
I COUNTY)
C VILLAGE
C CHECK ONE
AND
SPECIFY
D. STREET ADDRESS
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
3 A AGE 27 3B. DATE OF BIRTH Set>t. / 11
. . MONTH DAY
YES ~ NO
/1972
YEAR
13. A. AGE
26
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS Greenwich Public
15. PLACE OF BIRTH Tarrytown. New York
(CITY. STATE/COUNTRY IF NOT USA)
Schls.
4. EMPLOYMENT
A. USUAL OCCUPATION Insurance
B TYPE OF INDUSTRY OR BUSINESS Chubb
5. PLACEOFBIRTH Brooklvn.
(CITY. STATE/COUNTRY IF NOT USA)
Underwriter
GrouP
New York
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
Peter B. Dayger
USA
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
B. NUMBER OF THIS MARRIAGE
Lawrence J. Racioppo
USA
Josephine M. Cilmi
USA
J. Marini
Camille
USA
First
B. COUNTRY OF BIRTH
18. NUMBER OF THIS MARRIAGE First
DEATH
19. PREVIOUS MARRIAGES
A. NUMBE"l OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVCRCE CIVIL ANNULMENT
DEATH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
\2) = JE..\T''1
\31 c:J DIVORCE
.31 = ANNULMENT
/ /
YEAR
B. HOW DID LAST MARRIAGE END'
3\ L: DIVORCE
(3) C ANNULMENT
/ /
(2) = DEATH
B. HOW OlD ..AST MARRIAGE END?
v. DATE _~ST MARRIAGE ENDED?
C. DATE LAST MARRIAGE ENDED'
YEAR
MONTH DAY
::l. ARE ANY FORMER SPOUSE(S) ALIVE? = YES = NO
20. F PREVICUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMAT',ON
DATE ::F GECREE PLACE iSSUED AGAINST WHCM
'.MONTH. JAY. YEAR) (CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSe
MONTH DAY
D. ARE ANY FORMER SPOUSE(S\ ALIVE? = YES = NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEARI .CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST ~ 1ST
~D ~ ~D
3RD 3RD
~ ~n ~
I. being duly sworn. depose and say. that to the best of my knowledge and belief that the ,nformatiOn I provided is true and that I declare that no I
as to my right to enter into the marriag tate. ,
n
,.--
21 SIGNATURE OF GROOM ~
22. SIGNATURE OF BRIDE ~
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23. SUBSCRIBED AND SWORN TO BEFORE ME D t T
SIGNATURE OF TOWN OR CITY CLERK ~ epu y 0 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 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
~l i H~d T Cl k 25.A.SOLEMNIZATIONPERIODBEGINS
NAME (PRINT) _ _a ne ~ en, own er
IT TIME MONTH
SIGNATURE ~ t1..1 H ~ ~ 01~ DATE 7 /7/00
~ILING AD.QRESS 11 . 15AM
~.O. HOX 324, Wa in ers Falls NY 12590 .
s REEl I IT WN STATE ZIP I PM
~~~R~~~Ri~~~ 'O~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 rt< RELIGIOUS
DATE AND AT THE TIME AND 1'"
PLACE INDICATED 9 C OTHER. SPECIFY
YEAR
.-^-.
{ SEAL }
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7
8
00
9
5
00
28. PLACE WHERE MARRIAGE OCCURRED
::IVIL
A STATE NEW YORK B. COUNTY DUIt; k..:.
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 'SJ. VILLAGE OF
SPECIFY J/cpEUJeu.. :JUJ..X!:T7c;,J
F~ST ri5tt1<1 L.'"'
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TITLE(!~c.. pP 15/
DATE ~ Sri.... ~
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STATE
ZIP
31. WITNESS TO CEREMONY
NAME (PRINTI \