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:s I A II:. Ut" NI:.W YUHK.
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael Anthony Astacio
MIDDLE CURRENT SURNAME
o ~ 1ST 0 0
o 0 ~D 0 0
o 0 ~D 0 0
o 0 4TH 0 0
f my knDwledge and belief that the information I provided IS true and that I declare that no legal impediment eXists
22 SIGNATUREOFBRIDE~ C/ ~~-' ~
USE CUR USE CU NT N ~
23. SUBSCRIBED AND SWORN TO! IRMED BEFORE ME /18/2008
SIGNATURE OF TOWN OR CI CLERK ~ DATE
This license authorizes the marriage in New Y State of the bride and groom named above by any person authorized by New York Domestic
Relations Law 911 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) Jo C. Masterson
TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ DATE 11/18/2008
MAILING ADDRESS 1 0:46AM
"-y-I 20 Middle ush Rd, WappinQers Falls, NY 12590 PM 11
STREET CITYITOWN STATE ZIP
~~~R~:RT~~~ IO~O~~~N~:~ 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 AM
PLACE INDICATED. PM 9 0 OTHER, SPECIFY
COUNTY Dutchess
CITYiTOWN Wappinger
~~~~:f; 1368 '
~~~I~~~R 173
1 . A. FULL NAME
FIRST
11.
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE)115 68 9074
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY..o TOWN 0 VILLAGE
~~~CIFY WappinQer
D. STREET ADDRESS 5411 Princess Circle ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? '6 YES 0 NO
02 /03 /1977
MONTH DAY YEAR
3 A. AGE 31
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Bus Operator
B. TYPE OF INDUSTRY OR BUSINESS MT A
5. PLACE OF BIRTH Bronx, Ny
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Wilfredo Astacio
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Ada Rodriquez
B. COUNTRY OF BIRTH USA
B. 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 (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 07 / 14 / 2004 .
, MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ['fYES 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
08/08/2003 Staten Island, Ny
DEATH
o
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say, th
as to my right to enter intD the m
21. SIGNATURE OF GROOM~
w
en
z
w
o
::i
29. OFFICIANT
NAME (PRINT)
TITLE
SIGNATURE ~
MAILING ADDRESS
DATE
STREET
30. WITNESS TO CEREMONY
CITYiTOWN
NAME (PRINT)
SIGNATURE~
DOH.98 (0312006)
>01................."',........,.
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Aisha Marie Irizarry
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Astacio
(OPTIONAL. SEE REVERSE)124_60_5414
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY tJ TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESs5411 Princess CIrcle
ZIP 12590
DYES '6 NO
;1'972
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A AGE 36 3B. DATE OF BIRTH 09 /f 5
MONTH DAY
14. EMPLOYMENT
A USUAL OCCUPATION Bus Operator
B. TYPE OF INDUSTRY OR BUSINESS MT A
15. PLACE OF BIRTH EI Centro, Ca
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Edwin Irizarry
. B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Carmen Felicita Gonzalez
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. 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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
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
YEAR
19
2008
01
17 2009
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY
STATE
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~