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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
n::JniAI nAIr.::J~tAllo
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~: 1368
~5~1:~~R 107
1. A. FULL NAME
FIRST
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N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 134-46-0634
D. SOCIAL SECURITY NUMBER _ __ __ ____
2. RESIDENCE A. NY B. nllkhA~~
(STATE) (COUNTY)
C. CHECK ONE D CITY Il!!I' TOWN D VILLAGE
AND W .
SPECIFY appmger
D. STREET ADDRESS 21 0 Alpine Dr
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES r:1 NO
3 A. AGE 58 3B. DATE OF BIRTH n~ / ?Q / 1 Q~?
MONTH DAY YEAR
4. EMPLOYMENT
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A. USUAL OCCUPATION M;:mllf::Jdllring
B. TYPE OF INDUSTRY OR BUSINESS Lafarge Gypsum
5. PLACE OF BIRTH (;t~~T~~~~du~X IF NOT USA)
6. FATHER
A. NAME Fr::Jnk nAIr.::J~tAllo
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Angeline Stangarone
B. COUNTRY OF BIRTH Italy
8. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
1
(2) c(oEATH
2006 '
YEAR
B. HOW DID LAST MARRIAGE END? (3) D DIVORCE (3) D ANNULMENT
C. DATE LAST MARRIAGE ENDED? 12/ 31 /
MONTH .ry..Y
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES ~O
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL YI
I
L 0 SUPPLEMENTAL FILE
~
FROM THE BRIDE
Linda Louise Goidel
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Minnerly
c. SURNAME AFTER MARRIAGE DelCastello
(OPTIONAL - SEE REVERSE) 117 48 3859
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE D CITY iY TOWN D VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 21 0 Alpine Dr ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES r1 NO
12 /20 /1956
MONTH DAY YEAR
11. A. FULL NAME
13. A. AGE 53
13B.DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Nys Hairdresser/teacher
B. TYPE OF INDUSTRY OR BUSINESS CosmetoloQV
15. PLACE OF BIRTH Peekskill. Ny
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Leroy S. Minnerly
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Barbara G. Conklin
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 2
D
D
D
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) c(olVORCE (3) D ANNULMENT (2) D DEATH
C. DATE LAST MARRIAGE ENDED? 02/ 04 / 2009
MONT~ DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? U'YES D NO
"
20. IF PREVIOUSLY DIVORCED OR ANNULLED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEAR) (CITY/COUNTY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
02/04/2009 PouQhkeepsie, New York DO; D
D D
D D
D D
at I declare that no legal 1m ediment exists
....
DEATH
o
1ST
2ND
3RD
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2ND
3RD
4TH
I duly swear/affirm. depose and say, that to the best of
as to my right to enter into the mar~e state.
21. SIGNATURE OF GROOM~ p{..A
U
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State 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,
D 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) Jo C. Ma
TIME MONTH YEAR
SEAL SIGNATURE ~ DATE
'- -.J MAIL~B ~'Cfaf 11 :5S\M 08
-v- PM
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
NAME (PRINT)
SIGNATURE~
DOH-98 (09/2009)
DATE
08/23/2010
by New York Domestic
MONTH
YEAR
24
2010
10
22 2010
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
D CITY OF 0 TOWN OF iY'VILLAGE OF I.
SPECIFY "'Apco,-vo '-~ ~p~
NAME (PRINT)
SIGNATURE~