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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
.Jm:p.ph Inrlnvinn
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYITOWN Wappinger
~~~:~c: 1368 .
~~~~~~R 1 06
1. A. FULL NAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 150-30-2391
2. RESIDENCE A. NY B. nlltr.hp.~~
i5T ATE) (COUNTY)
C. CHECK ONE D CITY D TOWN /ill VILLAGE
~~~CIFY W::lppingp.rs Falls
D. STREET ADDRESS 31 South Mesier Ave. ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? r! YES D NO
3. A. AGE 69 3B. DATE OF BIRTH 04 / ?!i / 1 Q41
MONTH DAY YEAR
l-
S;
<C
C
u::
u.
<C
4. EMPLOYMENT
A. USUAL OCCUPATION nry r.lp.~ning
B. TYPE OF INDUSTRY OR BU~INESS Wappinger Clean Rite
5. PLACE OF BIRTH New York, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Vinr~p.nt Anthnny Inrlnvinn
B. COUNTRY OF BIRTH Italy
7. MOTHER
A. MAIDEN NAME Rosilia Consentino
B. COUNTRY OF BIRTH Italy
8. NUMBER OF THIS MARRIAGE 3
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
? 0
B. HOW DID LAST MARRIAGE END? (3) cYDIVORCE (3) D ANNULMENT
c. DATE LAST MARRIAGE ENDED? 12/ 15 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 0 NO
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
12/15/1982 Carmel. New York D d
12/21/1971 BerQen County. N.J. c1
DEATH
o
(2) D DEATH
1982
YEAR
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
CI~~~~a Ruth F~~~XNT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Inrlnvinn
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 079-44-8484
12. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE D CITY D TOWN r!f VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDRESS 31 South Mesier Ave. ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES D NO
13. A. AGE !iQ 13B.DATE OF BIRTH 11 /06 /4 950
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Registered Nurse
B. TYPE OF INDUSTRY OR BUSINESS Health Care
15. PLACE OF BIRTH Washington DC
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME James Edward Foley
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Phyllis Patricia Minor
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) dDIVORCE (3) D ANNULMENT (2) D DEATH
C. DATE LAST MARRIAGE ENDED? 04 / 27 / 1976
MONTH DAY - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? [rYES 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
04/27/1976 White Plains, New York c1
DEATH
o
1ST
D 2ND
D 0 3RD
D D 4TH
ledge and belief that the information I provided is tr
,
NAME (PRINT)
SIGNATURE~
DOH-98 (09/2009)
D
D
DATE
/2010
23. SUBSCRIBED AND SWORN T IRMED B
SIGNATURE OF TOWN OR CI CLERK ~
This license authorizes the marriage in New York State 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.
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)~ C. ~rson
{SEAL SIGNATURE~ e~i!l ~ ~ DATE 08/18/201 TIME MONTH YEAR MONTH YEAR
'-v-' "'"~ff,a'cli: ush Rd, WapPlngers Falls, NY 12590 02:1C: 08 19 2010 10 17 2010
STREET CITYITOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~.
THE MARRIAGE OF THE PER- .
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 D RELIGIOUS 1 IVIL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 D OTHER, SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY p~~ rf/Iff1J
C. LOCATION OF CEREMONY
(CHECK ONE ANDYPECIFY)
D CITY OF [JtTOWN OF D VILLAGE OF
SPECIFY-11hL, ('/1Jw tV
s
SIGNATURE~