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23lO
1. A. FUll NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseph Anthony DiGregorio
FIRST MIDDLE CURRENT SURNAME
I
5TAT~ ~ILC NUMDcn
(THIS SPACE FOR STATE USE ONLY)
COUNlY Dutchess
~OWN Wappinger
~~'::f~ 1368
~5~liJ~R 43
/ *1~,;lcO
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Laura Ella
FIRST MIDDLE
~
Wright
CURRENT SURNAME
11. A. FULL NAME
8 BIRTH NAME, IF DIFFERENT
8. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. Florida
(STATE)
C. CHECK ONE Xl CIIY 0 TOWN 0 VilLAGE
~~CIFY Riviera Beach
D. STREETADDRES9Ln~420 No. Ocean Drive ZIP 33404
E. IS RESIDENCE wffi~H~rfs OF aJ~ORPJ&Jo'WSGE? ~ YES 0 NO
13. A. AGE 14 13.8. DATE OF BIRTH April /19 /1966
MONTH DAY YEAR
2. RESIDENCE A.
086-46-5908
B. Palm Beach
(COUNTY)
DiGregorio
122-46-0219
B. Palm Beach
(COUNTY)
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
Florida
(STW)
c. CHECK ONE @ CIIY 0 TOWN 0 VilLAGE
~~~CIFY Riviera Beach
D. STREET ADDRESS 5420 No. Qcean Drive ZIP
E IS RESIDENCE WITHIN L1~r~~?cfry ~~~Jo~M~? Ki
3. A. AGE 47 3B. DATE OF BIRTH Feb. /17
MONTH DAY
33404
YES 0 NO
/1953
YEAR
14. EMPLOYMENT
4. EMPLOYMENT
A. USUAL OCCUPATION Architect
B. TYPE OF INDUSTRY OR BUSINESS Smith Architectural Grou
15. PLACE OF BIRTH poughkeepsie. New York
(CITY. STATElCOUNTRY"'iF NOT USA!
A. USUAL OCCUPATION Pilot
B. TYPE OF INDUSTRY OR BUSINESS Chandelle Avaiation
5. PLACE OF BIRTH (cITY.sTlEl~~~~~~fu~~e. New York
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Rita Sellers
USA
First
Benito DiGregorio
USA
Raymond Belch
USA
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Casimeri
Angelina
USA
Second
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
DEATH
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
One
DEATH
8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
'3) = ANNUL',\ENT
/ /
21 = DEATH
8. HOW DID LAST MARRIAGE END? ,31 ). DIVORCE '3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? Nov. / 16 / 1983
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? x: YES D NO
10. IF PREVIOUSLY OIVORCED OR ANNUlED, PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY. YEAR) (CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
11/16/83 poughkeepsie, NY ~ c
o r"
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? eYES = NO
20. IF PREVIOUSLY DIVORCED OR ANNUlED, PROVIDE THE FOllOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTIH. DAY. YEAR) (CITY. STATE/COUNTRY. IF NOT USAI SELF SPOUSE
21.
1ST
2ND
3RD
4TH
I, being duly sworn, depose an
as to my right to enter into the
~
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(.)
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23. SUBSCRIBED AND SWOR D t T wn C 1 rk
SIGNATURE OF TOWN 0 ITY CLERK ~ e u y 0 e
This license authorizes the marriage in New York Stat 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 cheeked, this license is to be used only for the pu se of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRIN~lain~ ~ Snowden, Town Clerk TIME MONTH DAY YEAR
SEAL SIGNATURE _'1.1 \.i~ 1I.\A~t'r DATE 4/20/00
MAILING ADDR - 10 : 30AM
'-.t-' PO Box 324 Wa in ers Falls, NY 12590 PM 4 21 00
SRE ClOWN A ZI
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER. M -
SONS NAMED ABOVE ON THE M DAY R 0 p..nELlGIOUS
DATE AND AT T1HE TIME AND 5 -AM 4 ....
PLACE INDIC~ED' '-o:>>Mi~~ "2-0= '0 0,"", """""
~:i~<;I~- \'-~\"T ,tv\~~-~ TITLE "~"\C)Q..
SIGNA~RE ~ ,~ - --- DATE 2.:l......
MAILING ADDR
\400 Ga~",o~ St. \>t),.)q\"\..ec\"'~
STREET . CITYITO~ T
30. WITNESS TO CEREMONY
"So~~
6
19
00
York Domestic
25. 8. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
DAY
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
1C CIVil
A. STATE NEW YORK B. COUNIY ~~~c.\t\4L"~
w
~
(.)
u::
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(.)
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
Qil CIIY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY Po u.. r; rHt.ti EfS" E"
"'e".w'i~
STATE
NAME (PRINT)
SIGNATURE ~