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CITYrrOWN Wappinger
~~~:~~T 1368
~~~~~~R 125
LJ~rt"\n I IVlt:I'l I VI- Hl::AL fH
AFFIDA VIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Fli~f'!o Lopf'!7
MIDDLE CURRENT SURNAME
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Jennifer Ann Murohv
MIDDLE tURRENT SURNAME
.-J
1. A. FULL NAME
11. A. FUll NAME
FIRST
FIRST
Q.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER 080-62 -7118
2. RESIDENCE A. NY B. DlJtche~s
(STATE) (COUNTY)
C. CHECK ONE 0 CITY >tJ TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D. STREET ADDRESS 27 Paulette Lane ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3. A. AGE 30 3B. DATE OF BIRTH On / 11 /1978
MONTH DAY YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 29 3B. DATE OF BIRTH 04 /1"1
MONTH DAY
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Lopez
(OPTIONAL - SEE REVERSE)054 74 2990
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE A.NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY tl TOWN 0 VILLAGE
~~~CIFY WappinQer
D. STREET ADDREss27 Paulette Lane
ZIP 12590
DYES '6 NO
/1"979
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Controller
B. TYPE OF INDUSTRY OR BUSINESS Wholesale Food
5. PLACE OF BIRTH Bronx. Ny
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Angel Luis Lopez
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Elisa Gonzalez
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION Sales Coordinator
B. TYPE OF INDUSTRY OR BUSINESS Garment
15. PLACE OF BIRTH Carmel, Ny
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Michael Benedict Murphv
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Julia Linda Evans
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
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
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
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say
as to my right to enter into the m
21. SIGNATURE OF GROOM
o 0 1ST 0 0
o 0 ~D 0 0
o 0 3RD 0 0
o 0 4TH 0 0
be t of my knowledge and belief that the information I provided is true and that I declare that no legal Impediment exists
23. SUBSCRIBED AND SWOR O/AFFI
SIGNATURE OF TOWN 0 CITY Cl
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriagB 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~ <;;J2"c1tLJ~,~..? DATE 09/03/2008 TIME MONTH YEAR MONTH
'-.,-I MA~~GICfFcf(~W~~Sh Rd, WapPingers Falls, NY 12590 06:49:~ 09 04 2008 11 02 2008
STREET CITYrrOWN STATE ZIP
~~~R~~~RT~: 'o~O~~~N~~~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY /'
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 Itl-6VIL
DATE AND AT THE TIME AND .) _ rI
PLACE INDICATED. Y PM ~D7> 9 0 OTHER, SPECIFY
J.
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY'V...:\-C.L.t)("
29. OFFICIANT
NAME (PRINT)
C. LOCATION OF CEREMONY
(CHECK ONE AND YECIFY)
o CITY OF c;v'fOWN OF 0 VILLAGE OF
SPECIFY U-J1\f( \ ~ C~
V
SIGNATURE ~
~L1N~DDRESS L ~
/., tJ 1(; k r 11.,1
STREET
30. WITNESS TO CEREMONY
g
/ <~.
. A ~I f"Y'I
i\\ ~1)'r
NAME (PRINT)
SIGNATURE~