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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
Rud{~rcWE GROOM
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is truJ::~:~~are that no legal Impediment exists
as to my right to enter into the marriage sta . .... I'!'" IlJ - .
21 SIGNATURE OF GROOM ~ t .' . SIGNATURE OF BRIDE ~ ~ .,
23. SUBSCRIBED AND SWORN TO BEFORE ME USE CURRENT NAME 1210612OO5 .
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York St named above by any 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.
o If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR ~e. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
~ ~~~.rN,,~=mD:l
STREET CITYITOWN STATE
~~~R~~~Ri~~~ 10~O~~~N~zi~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR
DATE AND AT THE TIME AND
PLACE INDICATED.
Dutchess
COUNTY \A".nger
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g:;i~g:1368
NUMBER 151
REGISTER
NUMBER
ii
1. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
I
51 A I ~ t'ILC nUM~n;;n
(THIS SPACE FOR STA TE USE ONL YI
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B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE ~1"
(OPTIONAL, SEE REVERSE)UI \r'UU"11 "t
o SOCIAl SECflliWl'S. It
2. RESIDENCE A.
Dutclless
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Yamilel Cano
11. A. FULL NAME
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(STATE) 01 B. (COUNTY)
C. X~6CK ONWaPiirfCjeri Fi& 0 VILLAGE
SPECIFY 6619 PrIncess CIrcle 12590
D. STREET ADDRESS Z~
E. IS RE~'CE WITHIN LIMITS OF CITY OR INCORPORATED1'llfGE? 2fP YES 1914
3. A. AGE 3B. DATE OF BIRTH /' /
MONTH DAY YEAR
4. EMPLOYMENT Superintendent
A. USUAL OCCUPATION Imperill Gardells Apl5.
B. TYPE OF INDLefiTCPMiB~6GtI8temaI8
5. PLACE OF BIRTH
(CITY. STATElCOUNTRY IF NOT USA)
6. FATHER Telmo Monroy
A. NAME Guetem8le
B. COUNTRY OF BIRTH
FIRST
MIDDLE
CURRENT SURNAME
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Saturnlna perez
A. MAIDEN NAME auatelllda
B. COUNTRY OF BIRTH 1
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVerCE CIVIL A'GULMENT
7. MOTHER
Dt) TH
B. BIRTH NAME (MAIDEN NAME), I~FFERENT
C. SURNAME AFTER MARRIAGE onroy
(OPTIONAL, SEE REVERSE) 101-86-2989
D. SOCIAL SE~~ER
12. RESIDENCE A. ork B. Dutchess
(STATE) J (COUNTY)
C. ~6CK ov.PJihg&sCfIi; 0 VILLAGE
SPECIFY 6619 PtI a .....
D. STREET ADDRESS ncess r",,8 ZIP 12590
E. IS RE~CE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
13. A. AGE 13.B. DATE OF BIRTH 07 09 1973
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Sales Associate
B. TYPE OF INDmr9.~ BUSf!u'1,e ~ MeR
15. PLACE OF BIRTH IiJUIn,
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER Alberto C8
A. NAME no
B. COUNTRY OF BIRTHCUbB
17. MOTHER G ciel G 'do
A. MAIDEN NAME f8 a am
B. COUNTRY OF BIRTHCUb81
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DtjORCE CIVIL A'trULMENT
Dt)TH
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
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
YEAR
ZIP
1~IL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEWYORK B. COUN~~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /'
o CITY OF 0 TOWN OF ~LAGE ~ II _
DSPECIFY Wk1PP'TAJ6~~
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 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
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29. OFFICIANT
NAME (PRINT)