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COUNTY
~OWN
DISTRICT
NUMBEFI
REGISTER
NUMBER
STATE O.E~N.~Wd~(OBK _~:r
DEPARTMENT OF HEALTH
AFADAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Peter Vincent
FIRST MIDDLE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
Dutchess
WappinRer
1368
35
/51,.'3/00
L 0 SUPPLEMENTAL FILE
~
1. A. FULL NAME
Stefonowich
CURRENT SURNAME
FROM THE BRIDE
Cristina Leigh
FIRST MIDDlE
Terzigni
CURRENT SURNAME
11. A. FULL NAME
Q.
N
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER
2. RESIDENCEA. New York
(STATE)
C. CHECK ONE 0 CITY IX TOWN 0
~~~CIFY Highland
D. STREET ADDRESS 8 Jonathan Court
ZIP 12528
DYES 00 NO
23 /1974
YEAR
B. BIRTH NAME (MAiDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York
(STATE)
C. CHECK ONE 0 CITY IX TOWN 0
AND
SPECIFY Wappinger
D. STREET ADDRESS 14 Pippin Lane ZIP 12590
E. is RESiDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES Xl NO
13. A. AGE....26.. .~. 13.B. DATE OF BIRTH July /28 /1973
MONTH DAY YEAR
B. BIRTH NAME. IF DIFFERENT
Stefonowich
114-62-5031
B. Dutchess
(COUNTY)
VILLAGE
086-60-3183
B Ulster
(COUNTY)
VILLAGE
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE 25 3B. DATE OF BIRTH July /
MONTH
DAY
4. EMPLOYMENT
14. EMPLOYMENT
A. USUAL OCCUPATION Graphic Designer
B. TYPE OF INDUSTRY OR BUSINESS Unemployed
15. PLACE OF BIRTH Mt. Kisco , New York
(CITY, STATE/COUNTRY IF NOT USA)
A. USUAL OCCUPATION S tuden t
B. TYPE OF INDUSTRY OR BUSINESS MountS t. Mary Co lIege
5. PLACE OF BIRTH Yonkers. New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Gail VanGo.rder
USA
First
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Vincent P. Stefonowich
USA
Frank Terzigni
USA
Rosemary Armstrong
Ireland
First
18. NUMBER OF THIS MARRIAGE
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
DEATH
B. HOW DID LAST MARRIAGE END? (3) C DIVORCE
C. DATE LAST MARRIAGE ENDED?
13) 0 ANNULMENT
/ /
(210 DEATH
B. HOW DID LAST MARRIAGE END? 1310 DIVORCE
C. DATE LAST MARRIAGE ENDED?
13) L ANNULMENT
/ /
(2) C DEATH
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) ,CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? = YES = NO
20. 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
1ST
2ND
3RD
4TH
I. being duly sworn, depose and say, that.
as to my right to enter into the marria~.
21. SIGNATURE OF GROOM ~
[J []
[J :::J
[]
u
C
o
o
Deputy
, 2000
W
en
z
W
(,)
::J
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York S te 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.
::J If checked, this license is to be used onl for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRIN~ Elaine )L.. Snowden, Town Clerk TIME MONTH DAY YEAR
SEAL SIGNATURE~UU~~~ DATE 4/11/00
MAILING ADDRE~li 11 : 15AM
'-.t-I PO Box j;!4, Wappingers Falls, NY 12590 PM 4 12 00
STREET ITY !TOWN ST A TE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27ZTYP F CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE IME MO. DAY YEAR 0 "" RELIGIOUS 1 == CIVIL
DATE AND AT THE TIME AND
PLACE INDICATED 9 L OTHER. SPECIFY
10
00
Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
DAY
YEAR
6
2B. PLACE WHERE MARRIAGE OCCURRE~
A. STATE NEW YORK B. COUNTY j/tt!CIfc:SS
29. OFFICIANT
NAME (PRINT)
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
::: CITY OF ::J TOWN OF ~~GE OF
SPECIFY U/ 4fl'J~~ ~ ;:;,,""'S
NAME (PRINT)
SIGNATURE ~
~ (111118)
NAME (PRINT)
SIGNATURE ~