On September 20, 2022 a
Exhibit,Appendix
was filed
involving a dispute between
Deborah V Grey,
and
Mary T Bassett Md Mpn
The Commissioner, New York State Department Of Health,
for Special Proceedings - CPLR Article 78
in the District Court of Albany County.
Preview
FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/21/2022
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Guardian...
Marriage
AFFIDAVIT
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License
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FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/21/2022
Orphans' Court Division
of
Court of Common Pleas
of
Philaclelphia County
COPY
10-30 (Rev. 11/09)
FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/21/2022
Commentnealti of Sennetbanfa:
County of $1flabelpf fa :s.
I
hereby the foregoing to be a true and accurate of
certify copy
.
MARRIAGE RECORD NO. 439529, CONSISTING OF COPY OF APPLICATION FOR NARR.IAGE AND
DUPLICATE CERTIFICATE OF MARRIAGE,
Orphans'
as the same appears of record in the office of the Clerk of the Court Division
of the Court of Common Pleas of Philadelphia County.
Witness hand and seal this--14th
my of said Court
RONALD R. DONATUCCI, ESQUIRE
REGISTER OF WILLS &
ORPHANS'
CLERK OF THE COURT
FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/21/2022
Conunantnealti of Sennsylbanfa:
County of SWlabelpWa :gs
Orphans'
I, JOSEPH D. O'KEEFE,-Administrative Judge of the Court Division
of Common
the Court of Pleas of rhiladelphia County, DO CERTIFY on behalf of the
Orphans'
Court Division that the Certificate Attestation made
foregoing of by
RONALD R.
DONATUCCI, Register of Wills and Ex-Officio Clerk of said
Orphans'
Court Division, whose name is thereto subscribed and of
seal his office affixed, is in due
form and made the proper
by officer.
In I have hereunto set
testhnony whereof, my hand, this
mnu_ the year of our Lord Two thousand and --(20 12
-3---
Joseph D. O Keefe, Admafaistrative Judge
Commentnealti of Senngplbanfa:
County of SUlabelpWa :ss
I, RONALD R. DONATUCCI, Register of Wills and Ex-officio Clerk of the
Orphans'
Court Division of the Court of Common Pleas of Philadelphia County, DO
CERTIFY, that the Honorable JOSEPH D. O'KEEFE, by whom the foregoing
Certificate of Attestation was made, and who has thereunto subscribed his name and was
Orphans'
at the time of Administrative Judge of the Court Division of
making thereof,
the Court of Common Pleas of Philadelphia County, duly
commissioned and sworn: to all
whose acts, as such full faith and credit, are to be givert
In whereof, I have hereunto set my hand and affixed the seal of the
testimony
Of- --en·
year our Lord Two
said Court, this-itthÄQy 3DHE of
thousand and-TWELCr20 12
Ronald R. Donatu
Orphans'
Register of Wills & Clerk of the Court
FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22
NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/21/2022
Commonwealth of Pennsylvania
**
County of Philadelphia
We, the
undersigned, in accordance with the statements hereinafter the facts set forth wherein we and
contained,
each of us do swear are true and
solemnly correct to the best of our knowledge and belief, do hereby make application
Orphans'
to the Clerk of the Court of Philadelphia for
County, Pennsylvania, a license to marry.
_.._........_ ..............._......__.. .. ._.._.....__..._.___..._._...__________... _.____....______._.._.. .
STATEMENT ALE
Full name and surname . . .__.__...._..____.____.. ___-.._____ ____ ____ Color _____. _ .--.-
s.
Relationship parties maki this a p licatio n y._..__..._......,_. . . ....... .. . .. . ... .. ._.. _.,.__..._.._...._. .._..__...._...._......
Occu ation . ..... ........___........__.. . ................_.. .._........ .._..._...... Birth 1 e ....._..._.. .............._....._..__. ... ..........__......_..._......_...__
Residence Date of B t
That he
mr- .-
h(s.-..... ....Q. ......._.._.....been led before, d b ..
·
........-......_._...._.._. . .
....._..._......_......_....................._..._.........__.__.._____...__.........._.........._............._......._............. ........ ... ............ ..........._._......................._.................._._.........- ... ...._
Is applicant afflicted with any transmissible diseas a.,.c._...-......._.- .............Name á urname of . r...... ... ..-............-........·-. ..-
Mother.._............................_.... _,........_..._. .......... ......h. ........................--..
.._.................................._...--.....-...s................................_...__.........................................-of
Maiden Name of Mot r.......................... ._....._............__.._....... ...........Residence of Fath r.. . ... .._..__...........-.. ......-.....- ..-...---.
of Mother .............,r- ....... ...... ._...._......_.......__..........._..._..... ..._..- C o 1 or o f F atter...........
1 ................_............o f . th er....._..............--............-.
Occu ation of Fat .
Bi r th p 1 ace o f F a t1 r ...___.__...._.._...__..._.............. . ._.o f M ot h( r........._.... .. ...-.....-..a....._.--- ----.-..---.- ------
'
Is applicant an of unsound npnd, or as a person o unsound mind, or un r the
imbecile, epileptic, undeqguardianship
mfluence Has apphcant within five years been a
any intoxicating hquor or narcotic degg.._._..._.....___....._... .._._..
inmate f
ny ounty asylum or home for indigent perso app n s P
C 1
Signature of Applicant
STAT MENT MALE
....._......._......................._...--..-...._.-------..-.....------------- Col r._._................ . .----
Full nam an rname..........._.._.....
P
POccu ation ...........-............_....._................. _.......... _. _................................. .Bir t 1 1 a c e ..... ..... ............................-.......... . -,.... .....-......_ .... ....
.
Document Filed Date
September 21, 2022
Case Filing Date
September 20, 2022
Category
Special Proceedings - CPLR Article 78
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Preview
FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22 NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/21/2022 I Ce nS Consent e Afidavit . o of .. Applicalit Parent for or Guardian O A F N D FEES Guardian... Marriage AFFIDAVIT ......................................................................... ... .... ....... .... ............ License [ Q 0 as o a o o .3 ! 3 3 U a O . . .m. c FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22 NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/21/2022 Orphans' Court Division of Court of Common Pleas of Philaclelphia County COPY 10-30 (Rev. 11/09) FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22 NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/21/2022 Commentnealti of Sennetbanfa: County of $1flabelpf fa :s. I hereby the foregoing to be a true and accurate of certify copy . MARRIAGE RECORD NO. 439529, CONSISTING OF COPY OF APPLICATION FOR NARR.IAGE AND DUPLICATE CERTIFICATE OF MARRIAGE, Orphans' as the same appears of record in the office of the Clerk of the Court Division of the Court of Common Pleas of Philadelphia County. Witness hand and seal this--14th my of said Court RONALD R. DONATUCCI, ESQUIRE REGISTER OF WILLS & ORPHANS' CLERK OF THE COURT FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22 NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/21/2022 Conunantnealti of Sennsylbanfa: County of SWlabelpWa :gs Orphans' I, JOSEPH D. O'KEEFE,-Administrative Judge of the Court Division of Common the Court of Pleas of rhiladelphia County, DO CERTIFY on behalf of the Orphans' Court Division that the Certificate Attestation made foregoing of by RONALD R. DONATUCCI, Register of Wills and Ex-Officio Clerk of said Orphans' Court Division, whose name is thereto subscribed and of seal his office affixed, is in due form and made the proper by officer. In I have hereunto set testhnony whereof, my hand, this mnu_ the year of our Lord Two thousand and --(20 12 -3--- Joseph D. O Keefe, Admafaistrative Judge Commentnealti of Senngplbanfa: County of SUlabelpWa :ss I, RONALD R. DONATUCCI, Register of Wills and Ex-officio Clerk of the Orphans' Court Division of the Court of Common Pleas of Philadelphia County, DO CERTIFY, that the Honorable JOSEPH D. O'KEEFE, by whom the foregoing Certificate of Attestation was made, and who has thereunto subscribed his name and was Orphans' at the time of Administrative Judge of the Court Division of making thereof, the Court of Common Pleas of Philadelphia County, duly commissioned and sworn: to all whose acts, as such full faith and credit, are to be givert In whereof, I have hereunto set my hand and affixed the seal of the testimony Of- --en· year our Lord Two said Court, this-itthÄQy 3DHE of thousand and-TWELCr20 12 Ronald R. Donatu Orphans' Register of Wills & Clerk of the Court FILED: ALBANY COUNTY CLERK 09/21/2022 12:24 PM INDEX NO. 907054-22 NYSCEF DOC. NO. 12 RECEIVED NYSCEF: 09/21/2022 Commonwealth of Pennsylvania ** County of Philadelphia We, the undersigned, in accordance with the statements hereinafter the facts set forth wherein we and contained, each of us do swear are true and solemnly correct to the best of our knowledge and belief, do hereby make application Orphans' to the Clerk of the Court of Philadelphia for County, Pennsylvania, a license to marry. _.._........_ ..............._......__.. .. ._.._.....__..._.___..._._...__________... _.____....______._.._.. . STATEMENT ALE Full name and surname . . .__.__...._..____.____.. ___-.._____ ____ ____ Color _____. _ .--.- s. Relationship parties maki this a p licatio n y._..__..._......,_. . . ....... .. . .. . ... .. ._.. _.,.__..._.._...._. .._..__...._...._...... Occu ation . ..... ........___........__.. . ................_.. .._........ .._..._...... Birth 1 e ....._..._.. .............._....._..__. ... ..........__......_..._......_...__ Residence Date of B t That he mr- .- h(s.-..... ....Q. ......._.._.....been led before, d b .. · ........-......_._...._.._. . . ....._..._......_......_....................._..._.........__.__.._____...__.........._.........._............._......._............. ........ ... ............ ..........._._......................._.................._._.........- ... ...._ Is applicant afflicted with any transmissible diseas a.,.c._...-......._.- .............Name á urname of . r...... ... ..-............-........·-. ..- Mother.._............................_.... _,........_..._. .......... ......h. ........................--.. .._.................................._...--.....-...s................................_...__.........................................-of Maiden Name of Mot r.......................... ._....._............__.._....... ...........Residence of Fath r.. . ... .._..__...........-.. ......-.....- ..-...---. of Mother .............,r- ....... ...... ._...._......_.......__..........._..._..... ..._..- C o 1 or o f F atter........... 1 ................_............o f . th er....._..............--............-. Occu ation of Fat . Bi r th p 1 ace o f F a t1 r ...___.__...._.._...__..._.............. . ._.o f M ot h( r........._.... .. ...-.....-..a....._.--- ----.-..---.- ------ ' Is applicant an of unsound npnd, or as a person o unsound mind, or un r the imbecile, epileptic, undeqguardianship mfluence Has apphcant within five years been a any intoxicating hquor or narcotic degg.._._..._.....___....._... .._._.. inmate f ny ounty asylum or home for indigent perso app n s P C 1 Signature of Applicant STAT MENT MALE ....._......._......................._...--..-...._.-------..-.....------------- Col r._._................ . .---- Full nam an rname..........._.._..... P POccu ation ...........-............_....._................. _.......... _. _................................. .Bir t 1 1 a c e ..... ..... ............................-.......... . -,.... .....-......_ .... .... .