154
~
<r-
>-
z
.;
I
I
I
J
!!It
r.m
w
I
m
w
a::
"
"
<{
,.
U-
ti
w
c-
m
~~~ W
t;:j~!;( ....
~ffi~ <C
~Ga5 0
~~@ u::
z- -
~~~ ....
[om a:
0"''' w
w~C3 0
b~"'
Z:::i~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Hector l1is otero, JR.
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York Sta person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within ew York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
D If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR C~ER Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) .
C 1~"1f2005 YEAR MONTH
SEAL SIGNATURE ~ DATE Q~
'-,-I M".20 h Rd, ppinger Falls, NY 12590
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
COUNTY Dutchess
CITYITOWl;I wappinger
DISTRICT 1368
NUMBER
REGISTER 154
NUMBER
1. A. .FULL NAME
CURRENT SURNAME
FIRST
MIDDLE
a.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 113-70-6833
D. SOCIAL SECNWiMBER
2. RESIDENCE A. York B. Dutchess
(STATE) ti (COUNTY)
C. CHECK ONi;. a L D. CITY 0 TOWN D VILLAGE
~~~CIFY waPPInger
D. STREET ADDRESS 42 De Garmo Hils Road ZIP ,~
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES ~ NO
3. A. AGE 20 3B. DATE OF BIRTH 06 /17 /1985
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Electrician
B. TYPE OF INDU6RY OR BUSI~U, S. Manne Corps
5. PLACE OF BIRTH ueen5, Yone
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Hector Luis otero
B. COUNTRY OF BIRTH Puerto Rico
7. MOTHER
A. MAIDEN NAME Merllyn Toro
8. COUNTRY OF BIRTH Puerto Rico
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV'5CE CIVIL AN~LMENT
w
...
j:!:
en
....
:>
<C
c
w-
coLL
:5LL
~<C
z
~
o
~
...
u
DEf)H
B. HOW 010 LAST MARRIAGE END? (3) D DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) D ANNULMENT
/ /
(2) D DEATH
a:
w
'"
::;
:0
Z
"
Z
<(
...
w
w
a:
...
en
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
D
D
D
21. SIGNATURE OF GROOM ~
w
en
z
w
o
::i
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L D SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. FULL NAME Christina Marie Wihlborg
FIRST MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Otero
(OPTIONAL. SEE REVERSE) 091-7~3393
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Westchester
(STATE) J (COUNTY)
C. CHECK O~~ D CITY Cl TOWN D VILLAGE
~~~CIFY YorktOwn
O. STREET ADDRESS &:tI"~~ Manor street
ZIP 10598
DYES~NO
t986
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 19 13.B. DATE OF BIRTH 2 A2
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Sb.rdent
B. TYPE OF IND~If.lY.QR 'j!q;lss 5Uny or Albany
15. PLACE OF BIRTH vvnne IS, NeW York
(CITY, STATE/COUNTRY IF NOT USA)
..
16. FATHER
A. NAME John Whlbarg
B. COUNTRY OF BIRTHU 5 A
17. MOTHER
A. MAIDEN NAME Theresa 81z8beth DonzeIla
B. COUNTRY OF BIRTHU S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIWRCE CIVIL ANbULMENT
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) D ANNULMENT (2) D DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
D
D
D
2 SIGNATURE OF BRIDE ~
ZIP
YEAR
02
19 2006
STATE
27. TYPE OF CEREMONY
o D RELIGIOUS
9 D OTHER, SPECIFY
1.--3 05
28. PLACE WHERE MARRIAGE OCCURRED
1~CIVIL
~jJr
A. STATE NEW YORK B. COUNTY
FORMER J.UPGE OF THE Clll
~~~;e~~~, ~)
bl:z.s MY /061/
STATE
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
~ CITY OF D TOWN OF D VILLAGE OF
SPECIFY li.h rR- f!~i/<l.f
u.h \ f<