174
1. A. FUll NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Noel Michael Frawlev
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
COUNTY Dutchess
CITYrrOWN Wappinger
~~J~~C: 1368 .
~~~~J~R 174
Lo
SUPPLEMENTAL FILE
FROM THE BRIDE
Aida Luz Reyes
MIDDLE CURRENT SURNAME
FIRST
11. A. FUll NAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
3B, DATE OF BIRTH
ZIP 12590
YES ~ NO
/ 1971
YEAR
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Frawley
(OPTIONAL - SEE REVERSE) 099-68-3822
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r:!! TOWN 0 VILLAGE
~~~CIFY PouQhkeepsie
D. STREET ADDRESS 2859 Route 9 D ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES tl' NO
11 /06 /1977
DAY YEAR
3B. DATE OF BIRTH
+
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 129 54 7773
D. SOCIAL SECURITY NUMBER --
2, RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY f!'5 TOWN 0 VILLAGE
~~~CIFY PouQhkeepsie
D. STREET ADDRESS 2859 Route 9 D
3. A. AGE 35
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
07 / 21
MONTH DAY
13. A. AGE 28
+
4. EMPLOYMENIT
A. USUAL OCCUPATION Railroad Conductor
B. TYPE OF INDUSTRY OR BUSINESS Metro North Railroad
5. PLACE OF BIRTH Bronx, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Michael Joseph Frawley
B. COUNTRY OF BIRTH Ireland
7. MOTHER
A. MAIDEN NAME Mary Elizabeth Murtagh
B. COUNlTRY OF BIRTH Ireland
8. NUMBER OF THIS MARF,lIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENIT
o 0
14. EMPLOYMENIT
A. USUAL OCCUPATION Domestic EnQineer
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Manhattan, New York
(CITY. STATE I COUNTRY IF NOT USA)
MONTH
~
W
rtJ
W
III
9
=>
0
:I:
rtJ
~
~
a
w
a:
w
~
it
a:
:i
...
0
w
~
()
ii:
~
w
()
w
a:
w a:
~ w
rtJ ~
rtJ =>
W Z
a: Q
c ~
c
< Iii
~ w
U ~
W
Q.
rtJ
16. FATHER
A. NAME Jose Reyes
'B. COUNTRY OF BIRTH Puerto Rico
17. MOTHER
A. MAIDEN NAME Nereida Cortes
B. COUNlTRY OF BIRTH Puerto Rico
lB. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVfOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENIT
1 0
DEATH
o
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEAJH B. HOW DID LAST MARRIAGE END? (3) ciDIVORCE (3) 0 ANNULMENT (210 DEATH
C, DATE LAST MARRIAGE ENDED? / / C. DATE LAST MARRIAGE ENDED? 1 0 / 02 / 1998
MONTH DAY YEAR MONT.':!.;o DAY, . - YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? U YES 0 NO
..
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE (MONlTH, DAY, YEA~ (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
o 0 1ST 1 0/02/199l:S Manhattan, New York c1 0
o 0 ~D 0 0
o 0 3RD 0 0
o 4TH 0 0
and belief that the information I provided is true gal impediment exists
w
en
z
-w
(,)
-:J
TIME
MONTH
YEAR MONlTH
YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
AM
12:15pM
11 01 2006 12 30 2006
~~z w'
?jE~
~>::;s ...
....ffiz <
~G~ (,)
~(!lc5 u::
I-Z(f.l _
~~~ ~
it~~ w
~w~ (,)
~ffiW)
ig~
29. OFFICIANIT
NAME (PRINT)
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COU~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF ~LLAGE O~ JL
'(JPECIFY fA) IWPIPl;.:6 ~ ~
SIGNATURE~
DOH-9B (0312006)
NAME (PRINT)
SIGNATURE~
"c.,