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~TATE UF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Javier E Galdames
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITY/TOWN WappinQer
~~~:~c; 1368
~5~I:l~R 75
1. A. FULL NAME
FIRST
0.
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)936 85 1083
D. SOCIAL SECURITY NUMBER --
2 RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWNoCI VILLAGE
AND W' F II'
SPECIFY applnQers a s
D. STREET ADDRESS 6601 Princess Circle ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES tJ NO
3. A AGE 30 3B. DATE OF BIRTH 03 / 14 /1979
MONTH DAY YEAR
4. EMPLOYMENT
A USUAL OCCUPATION Computer Tech
B. TYPE OF INDUSTRY OR BUSINESS Technology
5 PLACE OF BIRTH Tome, Chile
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A NAME Rafael E. Galdames
B. COUNTRY OF BIRTH Chile
7. MOTHER
A MAIDEN NAME Rosa Del Carmen Salazar
B. COUNTRY OF BIRTH Chile
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(2) 0 DEATH
(3) 0 ANNULMENT
/ /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY/COUNTY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
"''''It;. rl~1;. .'lumDc:n
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Karen V Troncoso
MIDDLE CURRENT SURNAME
~
11. A. FUll NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Galdames
(OPTIONAL. SEE REVERSE911_ 70-0369
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANY BDutchess
(STATE) J..., (COUNTY)
C. CHECK ONE I;J CITY Q TOWN U VILLAGE
~~~CIFYWapplngers rails
D. STREET ADDREss660 1 Princess Circle
ZIP 1208U
DYES v'D NO
)'985
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A AGE24 3B. DATE OF BIRTH 03 ~8
MONTH DAY
14. EMPLOYMENT
A USUAL OCCUPATION Computer Tech
B. TYPE OF INDUSTRY OR BUSINESS Technology
15. PLACE OF BIRTHSantiago, Chile
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Miguel E. Troncoso
'B. COUNTRY OF BIRTHChile
17. MOTHER
A. MAIDEN NAME Flor V. Sandoval
B. COUNTRY OF BIRTHChile
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DOORCE CIVIL A()ULMENT
Dt)TH
(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. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
o 0
o 0
o 0
o 0
t no legal impediment exists
1ST
2ND
3RD
4TH
I duly swear/affirm, aepose and say, that to th
as to my right to enter into the ~ .
21. SIGNATURE OF GROOM. .
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 ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) John C. Masterson
{ SEAL SIGNATURE~' DATE 07/21/2009
'-.-' MAI~~~~aT~ sh Rd, Wappingers Falls, NY 12590 1
STREET CITYITOWN STATE ZIP
~~~R~:RT~~lIO~O~~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER. SPECIFY
o
o
o
w
(/)
z
w
o
::::i
29. OFFICIANT
NAME (PRINT)
by New York Domestic
YEAR
CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN;;-j)~lr~J~
C. LOCATION OF CEREMONY
(CHECK ONE AN~ECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY E4S:;-- ,&;61, ~; U