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DISTRICT
NUMBER
REGISTER
NUMBER
51 A 1E OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
David Ernest
I"
ST A Tt: FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
Dutchess
Wappinger
1368
103
/,,\r\\OiJ
L [] SUPPLEMENTAL FILE
FROM THE BRIDE
Elizabeth Ann
~
Spescha
CURRENT SURNAME
1 A. FUll NAME
DiPrete
11. A. FUll NAME
FIRST
MIDDLE
FIRST
MIDDLE
CURRENT SURNAME
0-
N
B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER
2. RESIDENCE A New York B Dutchess
(STATE, (COUNTY)
C CITY ~ TOWN D VILLAGE
Poughkeepsie
D STREET ADDRESS 68 Cedar Avenue
558-58-9810
C CHECK ONE
AND
SPECIFY
ZIP 12603
E. IS RESIDENCE WITHIN liMITS OF CITY OR INCORPORATED VilLAGE' ...J YES Ki NO
3 A AGE 57 3B.DATEOFBIRTH July /27 /1942
MONTH DAY YEAR
33
13. A. AGE
MONTH
14. EMPLOYMENT
4 EMPLOYMENT
A. USUAL OCCUPATION Homemaker
B. TYPE OF INDUSTRY OR BUSINESS a t home
15. PLACE OF BIRTH Anchorage , Alaska
(CITY. STATEiCOUNTRY IF NOT USA)
16. FATHER
W
I-
0(
I-
<J)
A. USUAL OCCUPATION Systems Analyst
B. TYPE OF INDUSTRY OR BUSINESS Laerdal
Providence, Rhode Island
(CITY. STATEiCOUNTRY IF NOT USA)
5. PLACE OF BIRTH
6. FATHER
A. NAME Mario DiPrete
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Esther Gileau
B. COUNTRY OF BIRTH USA
Joseph Santo
USA
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Lorraine Forlano
USA
Second
8. NUMBER OF THIS MARRIAGE
Second
18. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil .ANNULMENT
One
DEATH
DEATH
B. HOW DID LAST MARRIAGE END? , 31 ~ DIVORCE (3) ;::: ANNULMENT (2) D DEATH
C DATE LAST MARRIAGE ENDED? May / 15 /2000
MONT~. DAY YEAR
D. ARE ANY FORMER SPOUSEIS) ALIVE? ~ 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
5/15/00 Yakima Co.. Wash. ~
B. HOW DID LAST MARRIAGE END? .31X: DIVORCE \3) L: ANNULMENT 2' = DEATH
C. DATE~STMARRIAGEENDED? Oct. /26 / 1999
MCNTH DAY
D. ARE ANY FORMER SPOUSEiS) ALIVE? x: YES ;::: NO
20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE CF ClECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY. STATE COUNTRY. IF NOT USA) SELF SPOUSE
10/26/99 Milford. Connecticut
YEAR
1ST
2ND
3RD
4TH
I, being duly sworn, depose and S
as to my right to enter into the ria
X::
w
en
z
w
o
;:j
1ST
2ND
:J 3RD
-1 ' 4TH
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
slale. a./,~ r....,j~
22~ SIGNATURE OF BRIDE ~ ~~ ~ ~
) USE CURRENT NAME
23. Town Clerk DATE June 27, 2000
This license authorizes the marriage in New York late 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.
:J 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 (PRIN~Elaine H. Snowden, Town Clerk
{SEAL SIGNATURE~'ll~~8AQ\AdDl. DATE 6/27/00 TIME MONTH DAY YEAR MONTH
MAILING ADDRES.s -. AM
'-.t-' PO Box j24, Wappingers Falls, NY 12590 12 '.15PM 6 28 00 8 26
STREET CITY TOWN STATE ZIP
\ CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE 0 D RELIGIOUS 1 CIVIL
DATE AND AT THE TIME AND
PLACE INDICA TED 9:J OTHER. SPECIFY
21. SIGNATURE OF GROOM ~
YEAR
00
28. PLACE WHERE MARRIAGE OCCURRED
/:! ~/
A. STATE NEW YORK B. COUNT:fi~~.5
C. LOCATION OF CEREMONY
,CHECK ONE AND SPE Y)
29. OFFICIANT
NAME (PRINT)
VILLAGE OF
NAME (PRINT)
SIGNATUR! ~
DOH-98 (11/98)