033
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 911 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 only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) ~ Elaine H. Snowden, Town Clerk
{SEAL SIGNATURE ~ dctuu U ~..urv....r:i ~I.... DATE 4 / 7 /2000 TIME MONTH DAY YEAR
MAI.l.JNG..ADDR~S. 8: 30 AM
'-y-l L'U .!Sox JL4, Wappingers Falls, NY 12590 PM 4 8 00
STREET CITYITOWN STATE ZIP
~~~R~~~Ri~~i IO~O~~~N~ZE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 [J RELIGIOUS 1 lit' CIVIL
DATE AND AT THE TIME AND III
PLACE INDICATED .., ~d
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STATE OF,.:NEWYORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Donald J.
FIRST MIDDLE
l
~~OWN
DISTRICT
NUMBER
REGISTER
NUMBER
Dutchess
Wappinger
1368
33
I STATE ALE NUMBER I
(THIS SPACE FOR STATE USE ONLY)
~. ~,,.~),z
Lo SUPPLEMENTAL FILE ~
11. A. FULL NAME
FROM THE BRIDE
Denise A.
FIRST MIDDLE
Warnell
CURRENT SURNAME
1. A. FULL NAME
Maffei
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B Dutchess
(STATE) . (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Eas t Fishkill
D. STREET ADDRESS 7 Dogwood Road ZIP 12533
Mooewell Junction
E. IS RESIDENCE WITHIN LIMITS OF CITY OR It4CORPORATED VILLAGE? 0 YES Xl NO
13.A. AGE 33 13.B.DATEOFBIRTH May /12 /1966
MONTH DAY YEAR
Maffei
086-58-8317
14. EMPLOYMENT
A. USUAL OCCUPATION Nail Technician
B. TYPE OF INDUSTRY OR BUSINESS Self employed
15. PLACE OF BIRTH Huntington, Long Island, NY
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME James F. Wornell
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME
Arlene Wauters
CURRENT SURNAME
B BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER
2 RESIDENCE A. New York
(STATE)
C. CHECK ONE D CITY ~ TOWN 0 VILLAGE
~~~CIFY East Fishki1l
D STREET ADDRESS 7 Dogwood Road ZIP
~ooewell Junct10n
E. IS RESIDENCE WITHiN liMITS OF CITY OR'1NCORPORATED VILLAGE? 0
3. A. AGE 46 3B. DATE OF BIRTH Sept. / 2
MONTH DAY
134-44-5943
Dutchess
(COUNTY)
B.
12533
YES Xi NO
/1953
YEAR
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE Fir s t
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
4. EMPLOYMENT
A. USUAL OCCUPATION Pro j ec t Spec ialis t
B. TYPE OF INDUSTRY OR BUSINESS Consolidated Edison
5. PLACE OF BIRTH New York City, New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
Donald J. Maffei, Sr.
USA
Pugh
B. HOW OlD LAST MARRIAGE END? (3) C DIVORCE
C. DATE LAST MARRIAGE ENDED?
,3) 0 ANNULMENT
/ /
2\ = DEATH
Margaret
Whales
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
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? c:: YES = NO
20. 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
,....
Deputy
DATE April 7 , 2000
by New York Domestic
B HOW DID LAST MARRIAGE END? (3) IX DIVORCE 131 0 ANNULMENT (2) C DEATH
C. DATE LAST MARRIAGE ENDED? J an. / 7 / 1991
MONTH DAY
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) (CITY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1/7/91 Poughkeepsie, NY ~
YEAR
1ST
2ND
3RD
4TH
I. being duly sworn, depose an
as to my right to enter into the
o
o
MONTH
YEAR
21. SIGNATURE OF GROOM ~ ..
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6
6
00
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY ~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
D CITY OF ~OWN OF = VILLAGE OF
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SIGNATURE ~
DOH-88 (\1181)
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