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STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Robert G.
FIRST MIDDLE
COUN;"Y
'~O?JN
DISTRICT
NUMBER
REGISTER
NUMBER
Dutchess
Wappinger
1368
31
1. A. FULL NAME
Hixon
CURRENT SURNAME
BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER
2 RESIDENCE A. New York
(S'I7.TE;
= CITY !Xl TOWN 0
Wappinger
o STREET ADDRESS 35 E Alpine Drive
C. CHECK ONE
AND
SPECIFY
054-74-1871
B. Dutchess
(COUNTY)
VILLAGE
ZIP 12590
E. IS RESIDENCE WITH,N LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
/ 31 /1978
DAY YEAR
3. A. AGE
21
Dec.
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Technician
B. TYPE OF INDUSTRY OR BUSINESS IBM Corp.
Bronx. New York
,CITY. STATE/COUNTRY IF NOT USA)
5. PLACE OF BIRTH
6. FATHER
A. NAME George Robert Hixon
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Sharon Ann Postrk
USA
First
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
OIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? 13) C DIVORCE
C. OATE LAST MARRIAGE ENDED?
(31 0 ANNULMENT
/ /
(2\;: DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D 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
/~'>\\o/)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Michele L.
Garofalo
CURRENT SURNAME
~
1,. A. FULL NAME
FIRST
MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York
(STATE)
C. CHECK ONE 0 CITY Ki TOWN 0
AND .
SPECIFY WapPl.nger
D. STREET ADDRESS 35 Alpine Drive, Apt.
Garofalo
083-62-7408
B. Dutchess
(COUNTY;
VILLAGE
E ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES Xl NO
13.B.DATEOFBIRTH Nov. /5 /1978
MONTH DAY YEAR
13. A. AGE
21
14. EMPLOYMENT
A. USUAL OCCUPATION Banking
B. TYPE OF INDUSTRY OR BUSINESS Hudson United
15. PLACE OF BIRTH Bronx. New York
(CITY. STATE/COUNTRY IF NOT USA)
Bank
16. FATHER
A. NAME Joseph Garofalo
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Barbara-Lynn
USA
First
Bachman
lB. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE 13) [] ANNULMENT
C. DATE LAST MARRIAGE ENDED? / /
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) ICITY. STATE/COUNTRY. IF NOT USA} SELF SPOUSE
c
0
'-' LJ
i' ...,
u
1ST
2ND
3RD
4TH
I. being duly sworn, depose and say
as to my right to enter into the m . .
21. SIGNATURE OF GROOM.
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 ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used ani for the pur ose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME IPRINT~ Elair~ ~ Snowden. Town Clerk TIME MONTH YEAR
SEAL SIGNATURE.~lILC B~rJ01_ DATE 4/5/00
MAILING ADDRESS 10 . QQAM
~ PO Box 324. Wappingers Falls. NY 12590 . p 4 6 00
STREET CITYITOWN TATE ZIP M
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. AY YEAR 0 C RELIGIOUS CIVIL
DATE AND AT THE TIME ~ND AM
PLACE INDICATED
L
w
U)
Z
W
o
::i
9 = OTHER. SPECIFY
Town
by New York Domestic
MONTH
YEAR
6
00
4
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ,.J.... fc4. ~
SoMf" ~ - t2. CO........1' )
TITLE _
">OM.-' ~dl~ 1 ~I 0'
STATE ZIP
31. WITNESS TO CEREMONY
C. LOCATION OF CEREMONY
(GjoiECK ONE ~~ SPECIFY)
<"". ~ OF ~W~OF P VILLAGE OF .
SPECIFY -n 11 '7 ~ I (..Q.. ~ Ps ,-f
c.;, + v
s<
NAME (PRINT)
SIGNATURE.