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COUNTY Dutchess
CITYrrow}! Wappinger
DISTRICT1368 .
NUMBER
REGISTER 51
NUMBER
;:) I A I C VI'"' I~CVV ,vn~
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Charles Michael Eurillo
(TH/S SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Julia Elizabeth McCord
--.J
1. A. FULL NAME
11. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
MIDDLE
CURRENT SURNAME
0-
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Eurillo
(OPTIONAL - SEE REVERSE060-64-6872
D. SOCIAL SE~tlTY NUMBER
12. RESIDENCE A. Y B. Dutchess
(STATE) .L (COUNTY)
C. CHECK Q.NI'. 0 CITY D- TQWN U VILLAGE
~~~CIFY vvapplngers t-alls
5'1-1 Sterling Drive
D. STREET ADDRESS
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)593-01-5975
D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. NY B. Dutchess
(STATE) .L. (COUNTY)
C. CHECK ONE 0 CITY 0 TOrrWU VILLAGE
AND W' F
SPECIFY applngers a s
D. STREET ADDRESS 511 Sterling Urlve
lL08U
MONTH
YES 0 NO
/1970
YEAR
Y)&~O
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Electrician
5. :~::~~:I::u~~rtl~~~i~~se~e~~~~al Contractor
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
6. FATHER
A. NAME XJOCX}DCX
, '. U::5A
B. COUNTRY OF BIRTH
A. NAME Charles Eurillo
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Eileen Chomko
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE L
17. MOTHER M r J lia McCord
A. MAIDEN NAME a y u
U::5A
B. COUNTRY OF BIRTH "
18. NUMBER OF THIS MARRIAGE
DEdTH
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A"B'ULMENT
D1tTH
0:'
W
II>
::!
:::l
Z
o
~
Ii;
W
0:
Ii;
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 2~&lEATH
C. DATE LAST MARRIAGE ENDED? 05 / 19 /
MONTI;!,; 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 PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEA.!l) (CITYICOUNTY, STATE/COUNTRY ~ NOT USA) SELF SPOUSE
1ST 05/19/200f St. Johns County, rlorida 0 [] 1ST
2ND 0 0 2ND
3RD 0 0 3RD
4TH 0 0 4TH
I duly swear/affirm, depose and say, that to the best of my knowledge and belief that the information I provided is tru
as to my right to enter into the ma~lt,~ ..
21. SIGNATURE OF GROOM~ .' /" - - 22. SIGNATURE OF BRIDE~
.. USE C R NT NAME
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 C ERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) JO C. Masterson
{SEAL SIGNATURE" DATE 06/01/2009
'-.-' MA~tfltWcfm sh Rd, Wappingers Falls, NY 12590
STREET CITYITOWN STATE ZIP
~~~R~~RTr~J 'o~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR o:fu RELIGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND AM
PLACE INDICATED. 3: 00 PM 7 / 4 / 09 90 OTHER, SPECIFY
YEAR
YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / (.
MONTH DAY YEAR
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
o
o
o
DATE
by New York Domestic
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COuNTYDutchess
29. OFFICIANT
NAME (PRINT)
TITLE Catholic Priest
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY f(\ \J(Ol~i'f S ; i..
Joseph P. LaMorte
d:~
S et Poughkeepsie
CITYfTOWN
DATE July 4, 2009
New York 12603
STATE
SIGNATURE ..
MAILING ADDRESS
77 5 Main
STREET
30. WITNESS TO CEREMONY
NAME (PRINT) William
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE"
SIGNATURE"
DOH-98 (0312008)