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Dutchess
Wappinier
1368
38
51 A 1E OF NEW ,YORK
DEPARTMENT OF HEALTH
AFRDAVIT,UCENSEand
. CERTIFICATE OF
MARRIAGE
FROM THE GROOM
J.
MIDDLE
r
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL YI
I
~ .}\}~\ 00
L 0 SUPPLEMENTAL FILE
~
FROM THE BRIDE
M. Cole
MIDDLE
Donna
FIRST
1. A. FULL NAME
Ruben
FIRST
De12ado
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Ku i an
c. SURNAME AFTER MARRIAGE Knj::m-nal gRdo
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER 115-60-9258
12. RESIDENCEA. New YOrk B Dutchess
(STATE) . (COUNTY)
o CITY XI TOWN 0 VILLAGE
Fishkill
o STREET ADDRESS 9 Briar Court
11. A. FULL NAME
CURRENT SURNAME
B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 584-34-2661
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A 1\TptJ Ynyk
mAlE)
o CITY ~ TOWN 0
Fishkill
o STREET ADDRESS 9 Brj aT CntlYT
C. CHECK ONE
AND
SPECIFY
nJt~hess
(C UN )
VILLAGE
C. CHECK ONE
AND
SPECIFY
B.
liP 12')24
liP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? t'l YES XI NO
13. A. AGE 18 13.B. DATE OF BIRTH Feb. /21 /1962
MONTH DAY YEAR
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES XI NO
/ 14 /1950
DAY YEAR
3. A. AGE
49
3B. DATE OF BIRTH Nov.
MONTH
14. EMPLOYMENT
4. EMPLOYMENT
A. USUAL OCCUPATION Secretary
P B. TYPE OF INDUSTRY OR BUSINESsMi n- Hlln !'lOTI Marl. Group
15. PLACE OF BIRTH Beacon. New York
(CITY, STATElCOUNTRY IF NOT USA)
A. USUAL OCCUPATION Phys ician
B. TYPE OF INDUSTRY OR BUSINESS Mid Hudson Medical Gro
5. PLACE OF BIRTH ~RTI ,Juan Puerto Rico
(CITY, STATElCOUNTRYIiF NOT USA)
16. FATHER
6. FATHER
A. NAME
Ruben
N. Delgado
Puerto Rico
A. NAME Robert Kuian Sr.
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Edna Giannini
B. COUNTRY OF BIRTH TT~A
18. NUMBER OF THIS MARRIAGE ~p('onrl
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
DEATH
B. COUNTRY OF BIRTH
7. MOTHER
Lillian Boneta
Puerto Rico
8. NUMBER OF THIS MARRIAGE Second
A. MAIDEN NAME
B. COUNTRY OF BIRTH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
DEATH
B HOW DID LAST MARRIAGE END? (3)181 DIVORCE (3) 0 ANNULMENT (2) U DEATH
C. DATE LAST MARRIAGE ENDED? May / 20 /1999
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? Jt YES ::J NO
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) :::: ANNULMENT 21 ~ DEATH
C. DATE LAST MARRIAGE ENDED? Mav /04 /1993
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? :l9 YES :::: NO
20. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
iMONTH. DAY, YEAR) (CITY. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
Dutchess Co. New York 5/4/93
/
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
poughkeepsie,New York ~/2n/qq ~ ~
xc
1ST
2ND
3RD
4TH
I. being duly sworn, depose and say, th
as to my right to enter into the marri
1ST
2ND
:J 3RD
D u 4TH
ge and belief that the information I provided is tru
and that I declare that no legal impediment eXists
1
r
w
en
z
w
(J
::i
21 SIGNATURE OF GROOM ~
23. SUBSCRIBED AND SWORN TO BEFOR~E
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
Elaine Town Clerk
\ DATE 4/14/00
Wappin2ers Falls, NY 12590
CITY,TOWN STATE
27. TYPE OF CEREMONY
13
00
DATE
4. - I 4-a::
by New York Domestic
25. B. SOLEMNIZA nON PERIOD
ENDS AT MIDNIGHT ON:
~
{ SEAL }
'-.t-l
YEAR
MONTH
DAY
YEAR
NAME (PRINT)
TIME
MONTH
SIGNATURE
MAILING ADDRESS
PO Box 324.
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
AM
PM
06
04
15
00
1:15
ZIP
28. PLACE WHERE MARRIAGE OCCURRED
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
AM
7;15 PM 4
1~ CIVIL
Putnam
o 0 RELIGIOUS
9 D OTHER, SPECIFY
A. STATE NEW YORK B. COUNTY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF 0 TOWN OF %J VILLAGE OF
20 2000
29. OFFICIANT M^ 0 : ~~~ A B .. 0
NAME (PRINT) ~ . ot.<<".a.nqeJl.
SIGNATURE ~ 4.d,11,o, tI. ~ #flLIJUO#l.
MAILING ADDRESS 7
85 Ma.in SVLeet. Cold S pJUnB .
STREET CITYfTOWN
30 WITNESS TO CER
TITLE
SPECIFY
Cold SpJUng
DATE
NAME (PRINn
SIGNATURE ~
IXlH-88 (111118)