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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Christopher A.
FIRST MIDDLE
23. SUBSCRIBED AND SWORN TO 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.
o If checked. this license is to be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR ~K 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) a ne H. S~den Town Clerk
SIGNATURE~ lAU ~~.A.hdt~ DATE 4/25/00 TIME MONTH DAY YEAR
MAILING ADDR~ AM 04 26 00
PO Box Jl4 Wa in ers Falls NY 12590 1:10 PM
STR ET A
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE 0 0 RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
COUNTY
~"*fTOWN
DISTRICT
NUMBER
REGISTER
NUMBER
Dutchess
Wappinger
1368
4')
I
STATE FILE NUllBER
(THIS SPACE FOR STATE USE ONLY)
I
1. A. FULL NAME
Vilato
CURRENT SURNAME
~ u,\~o1)
L 0 SUPPLEMENTAL FILE
.-J
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 116 - 70 -8 8 0 9
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New york
(STATE)
C. CHECK ONE ~ CITY 0 TOWN
~~~CIFY Yonkers
o STREET ADDRESS 37Ap~~rilh~rf8gii~1s ZIP 10703
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
3. A. AGE 29 3B. DATE OF BIRTH Sept. /11 /1970
MONTH DAY YEAR
B. Westchester
(COUNTY)
o VILLAGE
4. EMPLOYMENT
A. USUAL OCCUPATION Porter
B. TYPE OF INDUSTRY OR BUSINESS Sacred Heart
Yonkers New York
(CITY, STATE/COUNTRY IF NOT USA)
Housing
11. A. FULL NAME
FROM THE BRIDE
Elizabeth A.
FIRST MIDDLE
5. PLACE OF BIRTH
6. FATHER
A. NAME
Miguel A. Vilato
Cuba
Consavage
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Consavage
(OPTlONAL . SEE REVERSE) 063 66 2112
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE.\.. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY [X TOWN 0 VILLAGE
AND
SPECIFY Wappinger
D. STREET ADDRESS 7 Brothers Road
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 2 9 13.B. DATE OF BIRTH J an. /
MONTH
ZIP 12590
OYES~NO
28 A971
DAY YEAR
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME MarialFlena Hernandez
B. COUNTRY OF BIRTH Cuba
8. NUMBER OF THIS MARRIAGE First
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
14. EMPLOYMENT
A. USUAL OCCUPATION Reporter
B. TYPE OF INDUSTRY OR BUSINESS ..b~_bhar-Friedman
15. PLACE OF BIRTH Albany New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME
Francis G. Consavage
USA
B. HOW DID LAST MARRIAGE END? (3) C DIVORCE
C. DATE LAST MARRIAGE ENDED?
i3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME Teresa Dembski
B. COUNTRY OF BIRTH Germany
18. NUMBER OF THIS MARRIAGE Firs t
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
MONTH DAY YEAR
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, YEAR) ICITY, STATEiCOUNTRY.IF NOT USA) SELF SPOUSE
1ST 0
2ND 0
3RD 0
4TH 0
I, being duly sworn, depose and say. that to the best of my knowledge an
as to my right to enter into the marria 5 te.
21. SIGNATURE OF GROOM~
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{ SEAL }
~
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE :..AST MARRIAGE ENDED?
(3) C ANNULMENT
/ /
12) = DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ::J YES = NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. 'JAY. YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 1ST
o 2ND
o 3RD
o 4TH
lief that the information I provided is true an
c
""
=
eclare that no legal impediment exists
22. SIGNATURE OF BRIDE ~
Deputy Town Clerk
by New York Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
DAY
YEAR
06
24
00
28. PLACE WHERE MARRIAGE OCCURRED
1 '( CIVIL
A. STATE NEW YORK B. couNTV'V.GS1"~,btL
!lIA-o,C fZ-
.
0,,-/0 -00
JO$Z"
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
l)cCITY OF 0 TOWN OF 0 VILlLAGE OF
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29. OFFICIANT
NAME (PRINT)
TITLE
SPECIFY
NAME (PRINT)
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