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COUNTY Dutchess
CITYfTOW1'l wappinger
DISTRICT 1 3ot! '
NUMBER
REGISTER 14~
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Andrew Warren Woogen
MIDD~E CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
.-l
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Rebecca Ann Alfonso
1, A FU~ NAME
11, A, FU~ NAME
FIRST
MIDD~E
CURRENT SURNAME
FIRST
II.
F;j
B, BIRTH NAME (MAIDEN NAME)~IFFERENT
C, SURNAME AFTER MARRIAGE oogen
(OPTIONAL - SEE REVERSEJ! 07 -72-6~bU
0, SOCIAL S~U!;UTY NUMBER
'VA Monterey
12, RESIDENCE A. B,
(S~E) (COUNTY)
C, CHECK Q/'l; ,0 CITY 0 TOWN 0 VILLAGE
AND Manna
SPECIFY I 105 Jackson Court
D, STREET ADDRESS ,
E, IS RE~6NCE WITHIN LIMITS OF CITY OR INCORPORA1J~VILLAGE?'>3 0 YIj/>..Q,:!O
13, A. AGE 3B, DATE OF BIRTH L.. ~
MONTH DAY YEAR
B, BIRTH NAME, IF DIFFERENT
C, SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE'286-76-4862
D, SOCIAL SECURITY NUMBER
2, RESIDENCE A. CA B, Monterey
(ST.'\lE) (COUNTY)
C, CHECK ONi . ,LJ CITY 0 TOWN 0 VILLAGE
~~~CIFY Manna
D, STREET ADDRESS 1100 JacKSon (.;ourt ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? f
3, A, AGE 29 3B, DATE OF BiRTH 08 / 0
MONTH DAY
4, EMPLOYMENT
A, USUAL OCCUPATION Marine Technician
B, TYPE OF INDU:;1flY Qfl BUSINESS oceanograpny
5, PLACE OF BIRTH Mldaletown, OhiO
(CITY, STATE / COUNTRY IF NOT USA)
6, FATHER
A. NAME Warren Andrew Woogen
B. COUNTRY OF BIRTH USA
7, MOTHER
A. MAIDEN NAME Nancy Lynn Vonholt
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
Kim Hoolihan
A. MAIDEN NAME LJ S A
B. COUNTRY OF BIRTH I
18. NUMBER OF THIS MARRIAGE
93933
YES Cl..liO
/1 tltsO
YEAR
93933
14. EMPLOYMENT M d' I S'II
A. USUAL OCCUPATION e Ica I er
Medical
B. TYPE OF INDlJ.!iTRY OR aUSINESS
t"'lma AriZOna
15. PLACE OF BIRTH '
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER R b rt Alf 0
A NAME 0 e ons
. USA
B. COUNTRY OF BIRTH
17. MOTHER
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV~RCE CIVIL AN8ULMENT
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A'6'ULMENT
D'(t TH
DrooTH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEAJH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. -/ YEAR
YEAR
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE P~CE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY. STATEICOUNTRY, IF NOT USA) SE~F SPOUSE
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE P~CE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATElCOUNTRY.IF NOT USA) SELF SPOUSE
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I duly swe!lr/affirm, dep.ose and saXlJhlit _ 1I..best of my knowledge and belief that the information I provided Is tru
as to my nght to enter Into the l1)arrl~p~,; < ,t:'
21. SIGNATURE OF GROOM .- 74 1'/1,
_ USE CUR
23. SUBSCRIBED AND SWORN TOIAFFIRtylED'"BEFORE ME
SIGNATURE OF TOWN OR CITY CI.I!RK ~
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized
W Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
en 0 If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
Z ~ 24. TOWN OR CITY CI-ERKC M 25. A. SOLEMNIZATION PERIOD BEGINS
W } NAME (PRINT) JOnn . asterson
~ {SEAL SIGNATURE ~ DATE 12/14/2009 TIME MONTH YEAR MONTH
I- -.J MAI~~MPcJa1 ush Rd, Wappingers Falls, NY 12590 AM 12 15 2009 02
-v- 12:32pM
STREET ClTYrrOWN STATE ZIP
~~~R~:RT~~J IO~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M. DAY YEAR 0 I12f...RELIGIOUS
DATE AND AT THE TIME AND AM I n
PLACE INDICATED. --:./5' PM I fL ' & .. oLOO'! 90 OTHER, SPECIFY
29. OFFICIANT n n '" n n
NAME (PRINT) Kov VI. NPr"'!-. A JI.I.H~..<; TITLE _I'A-Q OLI-H A- L- VI C-fhL-
SIGNATURE~ ~ DATE I~ fIg! ~
MAILING ADDRESS c...---~ I
II e)..INtDN gT l,.Jf-I-f!,?/N4(:'t(5 FIl-LL\ N Y /25'<40
STREET CITYfTOWN STATE ZIP
30. WITNESS TO CEREMONY 31. WITNESS TO CEREMONY .~.I/
NAME (PRINT) C\,,\y/~ "-, ~VV\.?c...0 N NAME (PRINT) ~r:e0:o -~
SIGNATURE~ (:-.... SIGNATURE~~lJlj;L ~kJ
o
o
o
YEAR
12 2010
2B. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY J) uT C' i-l-f'~ <j
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF l2i VILLAGE OF
SPECIFY WA-P (J / N C(t:.eC FA--LLS