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COUNTY Dutchess
CITYrrOWN WappinQer
~~J:~ 1368 .
~5~I:J~R 92
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
ChristoRher Noel Alonso
MIDD E CURRENT SURNAME
I
STATE ALE NUM8EH
(THIS SPACE FOR STATE USE ONL Y)
I
SUPPLEMENTAL FILE
FROM THE BRIDE
Jamie Kristen Pa~e
MIDDLE CU RENT SURNAME
-.J
Lo
1. A. FULL NAME
11. A. FULL NAME
ARST
FIRST
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Alonso
(OPTIONAL' SEE REVERSE) 061-66-3660
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE) (COUNlY)
C. CHECK ONE 0 CITY r5 TOWN 0 VILLAGE
AND W .
SPECIFY appmger
D. STREET ADDRESS 98 Widmer Road ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VIUAGE? 0 YES d NO
13. A. AGE 25 3B. DATE OF BIRTH 11 /10 )1'980
MONTH DAY YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 088 64 21 06
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNlY)
C. CHECK ONE 0 CITY f!1' TOWN 0 VILLAGE
~~~CIFY WappinQer
D. STREET ADDRESS 98 Widmer Road
3. A. AGE 27
ZIP 12590
YES t1 NO
/ 1978
YEAR
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VIUAGE? 0
08 / 12
MONTH DAY
3B. DATE OF BiRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Carpenter
B. TYPE OF INDUSTRY OR BUSINESS Self-employed
5. PLACE OF BIRTH Manhattan, New York
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Ramon Joseph Alonso
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Margaret Rose Flynn
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARF,lIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
14. EMPLOYMENT
A. USUAL OCCUPATION Registered Nurse
B. TYPE OF INDUSTRY OR BUSINESS Vassar Brothers Med. Cntr.
15. PLACE OF BIRTH Poughkeepsie, New York
(CITY, ,STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME John Page
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Roseann Sottarelli
B. COUNTRY OF BIRTH U S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL AN~ULMENT
D~TH
DEATH
o
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
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNlY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.' ',- YEAR
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 ANNULLlED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNlY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
o
ent exists
23. SUBSCRIBED AND SWORN TO/AFFIRMED
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 authori ed
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 onl for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY.J C~RKC M t rs 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) 0 n . as e on
{SEAL } SIGNATURE ~
MAI~ Mfa~
'-v-I
07/11/200
DATE
appinger Falls, NY 12590
TIME
MONTH
YEAR
MONTH
YEAR
09 2006
09
AM
03:32pM
07
12
2006
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
ClTYrrOWN
26. SOLEMNIZATION OCCURRED
TIME AY Y R
ZIP
26. PLACE WHERE MARRIA~'F$s~
A. STATE NEW YORK B. COUNTY
C. LOCATION OF CEREMONY
(CHE70NE AND SPECIFY)
iY6ITY OF 0 TOWN OF 0 VILLAGE OF , / /..
SPECIFY ~ 1?~1Ie1/.p
10 CIVIL
NAME (PRINT)
SIGNATURE~