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COUNTY Dutchess
CITYfTOWN WappinQer
~~~:~;1368
~~~~J~R 42
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
JOS~I~D~E Patrick Jc?u~R~;" SURNAME
I
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Victoria Lee Almodovar
MIDDLE CURRENT SURNAME
-.J
1. A. FULL NAME
11. A FULL NAME
FIRST
FIRST
lL
N
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Joyce
(OPTIONAL. SEE REVERSE)078_68_6025
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA.NY B. Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY tJ TOWN 0 VILLAGE
~~~CIFY Wappinger
o STREET ADDREss2254 Route 9 D
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 744
D. SOCIAL SECURITY NUMBER 081-66-4
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY "I'J TOWN 0 VILLAGE
AND W .
SPECIFY applnger
o STREET ADDRESS 2254 Route 9 D ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
05 /07 /1982
MONTH DAY YEAR
3. A. AGE ?!1
36. DATE OF BIRTH
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE'
13. A. AGE 26 36. DATE OF BIRTH 11 /f 8
ZIP 12590
DYES 'ti NO
)1'981
YEAR
MONTH
DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Highway Management
B. TYPE OF INDUSTRY OR BUSINESS Transportation
5. PLACE OF BIRTH City Of Poughkeepie. NY
(CITY. STATE / COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION n/a
B. TYPE OF INDUSTRY OR BUSINESS n/ a
15. PLACE OF BIRTH City Of New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A NAME Steven Almodovar
'B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Lenamarie May
B. COUNTRY OF BIRTHU S A
lB. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH
o 0 0
6. FATHER
A. NAME D<=Ivid P<=Itrick Joyce
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Winona Mariorie Gadapee
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVILANNUL:MENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE'
(2) 0 DEATH
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
~
2D. 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
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
YEAR
MONTH 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, YEAR) (CITY/COUNTY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD D 0
4TH 0 0 4TH 0 D
I duly swear/affirm, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare th t no legal impediment exists
as to my right to enter into the mama state. , I 1. _ r.
21. SIGNATURE OF GROOM~ . 22 SIGNATURE OF BRIDE~ ~ - ,....tWJ
U E CURRENT NAME
DATE
05/02/2008
w
en
z
w
o
;:j
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
by New York Domestic
~
{ SEAL }
'-v-I
NAME (PRI
MONTH
YEAR
TIME
MONTH
YEAR
DATE 05/02/2008
ers Falls NY 12590
WN STATE ZIP
27. TYPE OF CEREMONY
o ~IOUS
9 0 OTHER, SPECIFY
AM
01:43PM
03
2008
07
01 2008
05
in
ITY
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
10 CIVIL
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
2B. PLACE WHERE MARRIAGE OCCURRED
!' ;'
OW~~~
A. STATE NEW YORK B. COUNTY
29. OFFICIANT
NAME (PRINT)
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~TOWN OF 0 VILLAGE OF
;JU:;'f..-!' " ~l'I- ",
SPECIFY j v~ iAJlv.Jy, N.....,.~V_
SIGNATURE ~
MAtJ!ltbDRESS f0
STREET
30 WITNESS TO CERE~Y
NAME (PRINT) i I (1/ cr-Il/'f Iv! . co rg
SIGNATURE~ t((4va~ /0/- c#-
DOH-98 (03/2006)
NAME (PRINT)
SIGNATURE~