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COUNTY
~';'OWN
DISTRICT
NUMBER
REGISTER
NUMBER
STATE OF:,,:NEW_.YORK
DEPARTMENT OF HEALTH
AFFIDA VIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
George J.
FIRST MIDDLE
FROM THE BRIDE
Rebecca A. Duncan
FIRST MIDDLE CURRENT SURNAME
Dutchess
Wappinier
1368
36
e- STATE RLE NUM8ER I
(THIS SPACE FOR STATE USE ONL Y)
~ 6/J-'3/0D
Lo SUPPLEMENTAL FILE -.J
1. A. FULL NAME
Piazza Jr.
CURRENT SURNAME
11. A. FULL NAME
0-
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAMEAFTERMARRIAGE Piazza
(OPTIONAl. SEE REVERSE)
D. SDCIALSECURITYNUMBER 077-68-193()
12. RESIDENCE,.\. N$WTE;Vork 8. ,~~~fhess
c. CHECK ONE 0 CITY 0 TOWN Xl VILLAGE
AND
SPECIFY W.<lpring,:>rS Falls
D STREET ADDRESS 39 South Ave ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE' ~ YES 0 NO
13. A. AGE 71 13.B. DATE OF BIRTH April / 30 /1978
MOtffi.I DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
0, SDCIAL SECURITY NUMBER
New York
(STATE)
o CITY 0 TOWN :KJ VILLAGE
Wappiniers Falls
19 South Ave.
2. RESIDENCE A.
052-68-6326
B. Dutchess
(COUNTY)
C. CHECK ONE
AND
SPECIFY
0, STREET ADDRESS
ZIP 12590
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES [] NO
3. A. AGE 22 3B.DATEOFBIRTH Dec. / 17 /1977
MONTH DAY YEAR
w
....
0(
....
(/)
4. EMPLOYMENT
14. EMPLOYMENT
A. USUAL OCCUPATION Clerk
B. TYPE OF INDUSTRY OR BUSINESS Royco Auto Parts
5. PLACE OF BIRTH Mt. Kisco. New York
(CITY. STATE/COUNTRY IF NOT USA)
A. USUAL OCCUPATION Daycare Provider
B. TYPE OF INDUSTRY OR BUSINESS Bui 1 dini Blocks
15. PLACE OF BIRTH Ponp'hkp.p.D!'li e New York
(CITY. STMi"COUNTRTIF NOT USA)
16. FATHER
A. NAME Ri chard Duncan
B. COUNTRY OF BIRTH lTSA
17. MOTHER
A. MAIDEN NAME
6. FATHER
A. NAME ~eorgp. Piazza Sr.
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Marie D'Apice
USA
First
B. COUNTRY OF BIRTH
18. NUMBER OF THIS MARRIAGE
B. NUMBER OF THIS MARRIAGE
9, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
19. PREVIOUS 'oIARRIAGES
A. NUM8E'l OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVC'lCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? (3) L: DIVORCE ,31 LJ ANNULMENT 12) L: DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES ::J NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
,.MONTH. DAY, YEAR) ICITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
B. HOW C;D.AST MARRIAGE END? 1310 DIVORCE ,31 = ~I>NULMENT 21 = DEATH
C. DATE ..AST MARRIAGE ENDED? / //
MONTH JAY "EAR
D. ARE ANY =ORMER SPOUSE(S) ALIVE? = YES = NO
2D. IF PREVIClS..y DIVORCED OR ANNULED. PROVIDE THE =CLLOWING 'NFORMATION
DATE :F JECREE PLACE ISSUED ~GAINST WHOM
,MONTH. JAY, YEAR) (CITY. STATE/COUNTRY. IF NOT ~SAI SELF SPOUSE
w
en
z
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::;
1ST 1ST
2ND 2ND
3RD 3RD
4TH 4TH
I. being duly sworn, depose and say, that to the best of my knowledge and belief that the information' provided is true and that I declare tha
as to my right to enter into the mar~e state. ,(). ir
21. SIGNATURE OF GROOM ~ .:2....i.tlt".I1J (), F..(.()M~ Y..-, 22. SIGNATURE JF BRIDE ~
"?~US~ RENTNA~
23. SUBSCRIBED AND SWORN TO BEFORE ME ,/
SIGNATURE OF TOWN OR CITY CLERK ~ 'V-
ThiS license authorizes the marriage in New York State of the bride and groom nameo above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
= If checked, this license is to be used only for the urpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRIN~ Elaine~nowden. Town Clerk
{SEAL SIGNATURE fY.l1J.~ \.\. ~J"".d" DATE h./13/()() TIME MONTH
MAILING ADDR S 11 : 3<AM 04 14 00
~ PO Box 324. Wappin~ers Falls. NY 12590 PM
STREET CITYTOWN STATE liP
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 c:: RELIGIOUS
DATE AND AT THE TIME AND 1'7.(0 .I\A
PLACE INDICATED /..{ _ PM 6 L{J 9 C OTHER. SPECIFY
~~~t~~~~~~' ~~,Alr ~. ~2l=-
SIGNATURE ~J
MAILIN~ .~1lI III
II ft1JSEle.VtJ I~ R.-. WA"P/~E45:
STREET CITYITOWN
30. WITNESS TO CEREMONY
.0.; H IV
00
De ut
no legal Impediment exists
Town
DATE 4- / 3 CD
by New York Domestic
YEAR
06
12
1,)!;.. :;:VIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 3. COUNTY "j)1fTCUGFSr:;.
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFYi
T1TLE~'R ~ ~lnIo
L: CITY OF ~ TOWN OF = VILLAGE OF.
SPECIFY p()()8-fri Ke 6t)~ I e.
DATE /flAt{ 2/. .2t1JtJ
FA~ )/~ I.:lSTIo
STATE
31.
NAME (PRINT)
SIGNATURE ~