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:s I A I t: UI- Nt:W YUHK. 'I
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
COUNTY nutr.he!':!':
CITYfTOWN Wappinger
~~J:k'ii 1 ?'''R
~~~~~R A
1. A. FULL NAME
C:hRnghnnn I ee
MIDDlE CURRENT SURNAME
FIRST
0-
N
B. BIFml NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCiAl SECURITY NUMBER nA7_Qn..nQ7n
2. RESIDENCEA.~ Vnrlr B. ~he!':!':
c, CHECK ONE 0 CITY IX TOWN 0 VILlAGE
AND W .
SPECIFY applngef
D. STREET ADDRESS 7R:\::\ Rnutp. 9 n Apt 11 ZIP 17~gn
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 "'lQo
3. A. AGE 43 3B. DATE OF BIRTH ns/ 19/ 101i
MCiiiffi!!" DA~ Y~
4. EMPLOYMENT
A. USUAL OCCUPATION WRitp.r
B. TYPE OF INDUSTRY OR BUSINESS n~hn R~~t$ll1rAnt
5. PLACE OF BIRTH (~~QWiJNOT USA)
6. FATHER
A. NAME Jony.nung I PP
B. COUNTRY OF BIRTH SOl db Korea
7. MOTHER
A. MAIDEN NAME HSAgs8e Chei
B. COUNTRY OF BIRTH South Korea
B. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
u.
c::c
DEATH
1 0 0
B. HOW OlD lAST MARRIAGE END? (3) 0 ~ORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 1Z 01/ 19S7
MONTH DAY yEAJi
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 'I'I!!k 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE.
12101/1931 Paraguay. So....h AmeAca
~
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
.-J
11. A. FULL NAME
FROM THE BRIDE
Sun Hee Kim
MIDDLE CURRENT SURNAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Kim
(OPTIONAl - SEE REVERSE)
D. SOCIAL SECURITY NUMBER n58-84-7153
12. RESIDENCE A. New Vnrk B. nlltr-hess
(!lTmi ~)
C. CHECK ONE 0 CITY KI lI/5WN r:! VILLAGE
AND W . ,
SPECIFY app1nger
D. STREET ADDRESS iR33 Rnutp. 9 0 Apt 11 ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 '!to
13. A. AGE 40 13.B. DATE OF BIRTH MO~ / o'il /1:lf2
14. EMPLOYMENT
A. USUAL OCCUPATION ~nll~p.~
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRlJi (C~~~1MlViJNOT USA)
16. FATHER
A. NAME Hung .lImp Kim
B. COUNTRY OF BIRTH ~nllth K()re~
17. MOTHER
A. MAIDEN NAME Ok Wha Choi
B. COUNTRY OF BIRTH South Korea
lB. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
1 0 0
B. HOW DID lAST MARRIAGE END? (3) 0 o1f'ORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? Or 06 / ., ags
MONTH DAY Y~
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 ~ 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
OJJ.Oif199g PUIsRkwangyuk, Korea
~ 0
o 0
o 0
o 0
Iment eXIsts
IS true and that I declare t at no legal 1m
. SIGNATURE OF BRIDE ~ ~ ~
- USE CURRENT NAME
23. ~~~~=~~f,.o=~ri~B~~i~E. DATE n1!7Q/7nn3
This license authorizes the marriage in New York 8ta and groom named above by any person authorized by New York Domestic
Relations Law 511 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 onl ose of a second or subs uent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
~
{ SEAL }
'-..,-I
NAME (PRINT)
TIME
MONTH
YEAR
MONTH
YEAR
IP
08:~
30 2003.
01
30
20303
27. TYPE OF CEREMONY
o 0 RELIGIOUS 1~IVIL
9 0 OTHER, SPECIFY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~OWN OF 0 VILLAGE OF
SPECIFY~ilLje r
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT) ~ \.e l \e lc (\ l.:'"""'
SIGNATURE~ ~\ P l \ 1l \JJ ~