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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael G Hanna~n
MIDDLE CURR SURNAME
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I, being dUly swom, depose and say, thaI to the best OJ.",/ m knowledge and belief thaI t e information I provided IS true and that I eclare that no legal impediment exists
as to my right to enter into the marriage stat . tf&t.. ..
21.SIGNATUREOFGROOM~ l us C;;URR~ 22.SIGNATUREOFBRIDE~ ~~EC~~~J~~~
23. ~~JA~=~DO~~O~~: ri({yBg~~~E DATE 12/'3000'
This license authorizes the marriage in New York S te of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies withi New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked, this license is to be used only for the urpose of a second or subsequent ceremony.
24. TOWN OR cm CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
::i
CbUNTY Dutchess
CITYfTOWN Wappinger
~~J:~~ 1 ::'.68
~3~~J~R 194
1. A. FULL NAME
FIRST
a.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 064-64-4734
2. RESIDENCEA.----fittwY York B. (~MlRhess
c. CHECK ONE 0 cm 0 ..6WN 0 VILLAGE
~~CIFY Pnughkeepsie
D. STREET ADDRESS 621 Sheafe Rnad #118 ZIP 12601
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 't(o
3. A. AGE 37 3B.DATEOFBIRTH J1/ DAP6 / yJ96
4. EMPLOYMENT
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ic:C
A. USUAL OCCUPATION CIJ~tndi8n
B. TYPE OF INDUSTRY OR BUSINESS KRfom'lh , p.wi!; _ Roro
5. PLACE OF BIRTH MRnhHHRn Np.w York
(CITY, STA~Nffi"V'IF NO""!' USA)
6. FATHER
A. NAME ~enrge Hannagan
B. COUNTRY OF BIRTH I J ~ A
7. MOTHER
A. MAIDEN NAME
iL
...JLL
-c:s:
CatheriR8 Smith
"SA
1
B. COUNTRY OF BIRTH
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
n n
DEATH
n
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
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) (cm, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
II:
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{ SEAL }
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NAME (PRINT)
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
Lo
~h~ .&~ 73
rl-,;ft /.1-(1.8
SUPPLEMENTAL FILE
FROM THE BRIDE
Arlene Jallorina
MIDDLE CURRENT SURNAME
11. A. FUll NAME
FIRST
B. BIRTH NAME {MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Hannagan
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. ~vt York
c. CHECK ONE 0 CITY 0 1'6wN
~~CIFY Poughkee.psie
D. STREET ADDRESS ~21 Sheafe Road #118 ZIP 12601
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 '1(0
13. A. AGE ~6 13.B. DATE OF BIRTH 1 ~ / 19 /1 Qf\6
MONTH DAY YEAR
B. g~~ess
o VILLAGE
14. EMPLOYMENT
A. USUAL OCCUPATION Unemployed
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH AanRhHn NUP.VR Vizr.a. ya. Philippines
(CITY, ~Y IF NOT USA)
16. FATHER
A. NAME Alejandre Jallnrina
B. COUNTRY OF BIRTH Philippinp.~
17. MOTHER
A. MAIDEN NAME P'Jrificacion Gacosta
B. COUNTRY OF BIRTH Philippinp.!\l
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
n n
DEATH
n
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE . (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? / /
(2) 0 DEATH
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) (cm, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
TIME
MONTH
YEAR
MONTH
YEAR
ZIP
AM
02:n'
21 2003
12
24
20 2 02
~CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~:t>L.Jt~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WN OF 0 VILLAGE OF
SPECIFY 1J... h HI ~ e.-r
~qo
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE ~