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COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c: 1368 .
~~~I~~~R 76
;) I A I J:: Ur- NJ::W YUHf\.
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Charlie Alvarez, Jr.
MIDDLE CURRENT SURNAME
FIRST
MIDDLE
CURRENT SURNAME
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Dana Anne Williams
.J
1 . A. FULL NAME
11. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Alvarez
(OPTIONAL - SEE REVERSE>1 01-68-2547
D. SOCIAL SECURITY NUMBER . . .
12. RESIDENCEA.NY BDutchess
(STATE).L (COUNlY)
C. CHECK ONE Q CITY UTOWN 0 VilLAGE
~~~CIFY Wappmger . . .
D. STREETADDRESs160B Koute H, 11g
.t.
o YES 0 NO
)982
YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSEI116_56_0723
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE) (CDUNlY)
C. CHECK ONE 0 CITY ~ TOWN 0 VilLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 1668 Route 9, 11 G
l~b!::lU
ZIP
3. A. AGE 34
'12590
ZIP
YES"6 NO
/ 1974
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIlLAGE?
13. A. AGE27 3B. DATE OF BIRTH 05 }O7
MONTH DAY
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
09 / 08
DAY
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A. USUAL OCCUPATION Nuclear Security
B. TYPE OF INDUSTRY OR BUSINESS Nuclear Power Plant
5. PLACE OF BIRTH Manhattan, NY
(CITY, STATE I COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Nurse. .
B TYPE OF IND~TRY OR IiIUSINESS Health Care
15. P~CE OF BIRTHr.'oughKeepsie, Ny
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Edward Patrick Williams
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Anne Patrice Appleton
B. COUNTRY OF BIRTHU S A
1
16. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A~ULMENT
D10'TH
6. FATHER
A. NAME Charlie Alvarez
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Abigail Rosario
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 07 / 24 /
MONT~ DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
1D. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) . . \CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 07/24/2006 vvestchester, Ny 6
2ND 0
3RD 0
4TH
I duly swear/affirm, depose and say
as to my right to enter into the m I
DEATH
o
@ Q DEATH
2u06 '
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. ~ YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
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 PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
YEAR
o 0
o 0
o 0
21. SIGNATURE OF GROOM ~
DATE
07/21/2009
USEC
23. SUBSCRIBED AND SWORN TO/AFFIRMED 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 only for the purpose of a second or subsequent ceremon .
~ 24. TOWN OR CITY Cl-ERKC M 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) JOnn . asterson
{SEAL SIGNATURE ~ .. DATE 07/21/2009 TIME MONTH YEAR
"- -.J MAI~~M'P~&f~ sh Rd, Wappingers Falls, NY 12590 AM 07 22 2009
-v- 02:45 PM
STREET CITY/TOWN STATE ZIP
~~~R~~R;~~ 'o~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 ~ CIVIL
DATE AND AT THE TIME AND..lW- Q
PLACE INDICATED. I a.:COpM q - . b - D -/ 90 OTHER, SPECIFY
by New York Domestic
MONTH
YEAR
19 2009
09
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNwD (,{r~~LE5
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF kf TOWN OF O. VILLAGE OF
SPECIFY uJ Aff;r tip E R
NAME (PRINT)
SIGNATURE~
j
,
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