018
UI
~~~ W
f-~f- ~
ll!l€~ _
f-w Z .....
g:jd~ 0
::iCl6 u::
~~(/) -
13~l'; ~
[tOUl a:
Of-> W
W~<5 0
b~'"
z~~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Wu Y ong Huang
MIDDLE CURRENT SURNAME
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New Yo bride and groom named above by any person
Relations Law ~11 to perform marriage ceremonies hin New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked. this license is to be used onl ur ose of a second or subse uent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
I
02128/200
F ails NY 12590
A
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
]
COUNTY Dutchess
CITYfTOWN Wappinqer
~~J:~~ 1368
~5~~l~R 1 a
1. A. FULC NAME
FIRST
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 098-70 ')840
D. SOCIAL SECURITY NUMBER -oJ
2. RESIDENCE A. New York B. Kinas County
(STA~ ~
C. CHECK ONE ~ CITY 0 TOWN 0 VILLAGE
~~~CIFY Brooklyn
STREET ADDRESS 184B BOth Street ZIP 11214
IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? r:f YES 0 NO
02 / 04 / 1974
MONTH DAY YEAR
D.
E.
3. A. AGE 79
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Computer Technician
B. TYPE OF INDUSTRY OR BUSINESS Comouforce
5. PLACE OF BIRTH CantolJ~_~hina
(CITY, STATEJ(;(JlJNTRY IF NOT USA)
6. FATHER
A. NAME Yu Min Huana
B. COUNTRY OF BIRTH China
7. MOTHER
A. MAIDEN NAME Xin VAn MAi
B. COUNTRY OF BIRTH China
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVOFlCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
a:
w
"'
::i
:J
Z
o
Z
...
f-
W
W
a:
f-'
rJJ
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
o
o
o
W
en
z
W
o
::i
r-I'-.
{ SEAL}
'-v-I
NAME (PRINT)
SIGNATURE ~
MAILING ADqRESS
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
NAME (PRINT)
SIGNATURE ~
DOH-98 (11198)
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
Lo
11. A. FULL NAME
SUPPLEMENTAL FILE
FROM THE BRIDE
Fa Hoi Cheung
MIDDLE CURRENT SURNAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Cheung - Huang
D. sJg~II~c'L:-Ri;E;u~~~~ASE) 059-80-7818
12. RESIDENCE A. New York B. Dutchess
(STATE) "" (COUNTY)
C. CHECK ONL. Q CITY 0 TOWN 0 VILLAGE
~~CIFY wappinger
D. STREET ADDRESS 3~ ReggIe Dnve
ZIP ll~~U
....
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES Q NO
13.A. AGE 25 13.B.DATEOFBIRTH 11 /10 A'd71
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION T eiler
B. TYPE OF INDUSTRY OR BUSINESS Trustco Bank
15. PLACE OF BIRTH Canton, China
(CITY, STATE/COUNTRY IF NOT USA)
18. FATHER
A. NAME Tim Chun Cheung
B. COUNTRY OF BI~TH China
17. MOTHER
A. MAIDEN NAME Kwai Chun Lam
B. COUNTRY OF BIRTH China
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) GANNULMENT (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
o 0
o 0
o 0
o 0
I impediment exists
22. SIGNATURE OF BRIDE ~
TIME
. MONTH
YEAR
AM
01 :4l)M
03
l'~IVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY'~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o "'" 0' 0 rowN '" ~'"'f' '"
SPECIFY ~ ~Ifs
ZIP
31. WITNESS TO CEREM Y
~ME (PRINT)
SIGNATURE ~