068
]
b
I.D
r"
T'""
.::&
....
0
r
~ w
Q) >-
;:
Z Ul
Q)
'"
0-
Q)
~(I) t::
~ ~
O:J C
50 ~ u::
r-ju..
z": ~ <t
9:J "
~o 0
~';:
C/JL. >-
6(00
:tc
~c
~o
~
=>:J
m:
~
u
c;m
tp.I
w
U
w
a:
w
I
"
UJ
J)
w
a:
o
o
'"
i::
u
w
"-
UJ
ZIZ
2~~ w
~~~ I-
>-ffiZ <t
gjdr5 U
~~8 u::
z- -
G~5 ....
ttOUJ a:
0>->- W
Li.j::gC'i U
~zUl
ot'i
Z:J~
COUNT,Qutchess
CITY TOWNWappinger
~~~~~CR1\ 368
~~~I~J~F68
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Anthony J. Sandy
MIDDLE CURRENT SURNAME
CURRENT SURNAME
I
::t I A I C r-ILC r4UMDC;n
(THIS SPACE FOR STA TE USE ONL Y)
dt/lt
, 1'7< Ii/I
(f'~ - l/rA
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Sharon A. Castro
-.J
A FULL NAME
11. A FULL NAME
FIRST
FIRST MIDDLE
BIRTH NAME (MAIDEN NAME). IF DIFFEREN~uger
C SURNAME AFTER MARRIAGE Sandy
(OPTIONAL - SEE REVERSE066-68-0058
o SOCIAL SECURITY NUMBER
12 RESIDENCE ANew York BDutchess
(STATE) 'It! (COUNTY)
C CHECK ONE Y CITY \,J TOWN 0 VILLAGE
~~~cIFPoughKeepsle
D STREET ADDRES?9 E Hudson Harbour
ZIP'12601
....
DYES 0 NO
1967
0-
N
B BIRTH NAME. IF OIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSI085-52 5339
o SOCIAL SECURITY NUMBER -
2 RESIDENCE A New York B. Dutchess
(ST A TEl ..I. (COUNTY)
C CHECK ONE 0 CITY 0 TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D STREET ADDRES~ Field Court
3 A
AGEAO
12
ZIP '1260'1
~
YES 0 NO
/1961
YEAR
YEAR
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13 A. AG~ 13.B. OATE OF BIRTH 11 )t'3
MONTH DA Y
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A USUAL OCCUPATIONDomestic Engineer
4 EMPLOYMENT
A USUAL OCCUPATION Union Electrician
B TYPE OF INDUSTRY OR BUSINESsLocal 363
PLACE OF BIRTrPoughkeepsie, New York
ICITY. STATE,COUNTRY IF NOT USA)
B TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRT~oughkeepsie, New York
(CITY. STATE'COUNTRY IF NOT USA)
16. FATHER
A NAM~ohn Ruger
B COUNTRY OF BIRTtV S A
17. MOTHER
A. MAIDEN NAMESandra Lopez
B. COUNTRY OF BIRTM S A
18. NUMBER OF THIS MARRIAGE 2
19 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
DEATH
o
6 FATHER
A. NAME Robert Sandy
B COUNTRY OF BIRTHU S A
7 MOTHER
A. MAIDEN NAME Marlene Hamifion
B. COUNTRY OF BIRTH USA
NUMBER OF THIS MARRIAGE 2
9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
DEATH
o
.,;
B. HOW DID LAST MARRIAGE END? (31::J DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 02 /15 /2002
MONliiI' DAY YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
v-
B HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 05 /03 /2001
MONIlt' DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
:;:
~
~
co
~
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION 20 IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY. YEAR) (CITY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY, STATE, COUNTRY, IF NOT USA) SELF SPOUSE
15T05/03/2001 PouahkeeDsie. New York 0 ~ 15T02115/2002 Pouahkeepsie. New York [I'j 0
2ND 0 0 2ND 0 0
3RD 0 [J 3RD 0 0
4TH 0 0 4TH C 0
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the m' state. Q l. n____
21 SIGNATURE OF GROOM ~ ... ~ 2 SIGNATURE OF BRIDE ~ '- \h.()rvv- po. ~
USE CURRENT NAME
DATE OS/23/2002
w
~
g:
U'
w
en
z
w
U
::::i
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State person authorized by New York Domestic
Relations Law !j11 to perform marriage ceremonies within Ne 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 CITY CL.ERK 25. A SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Glo
{_TIME MONTH YEAR MONTH
SEAL SIGNATURE ~
MAlj"l~~Qj'J_~~ 8:37 AM
'-y-I LU MJOOleDUsh Rd, PM 05 24 2002 07 22 2002
STREET ZIP
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
YEAR
<CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY ~Il~ \')'5:
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
= CITY OF _~WN OF 0 VILLAGE OF
SPECIFY t ..l..\'" ~ f 'f ]l 'J e ('
29. OFFICIANT
NAME (PRINT)
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
Fln,eEI'vCC tf=~
.5- ~tAP-tAC tJl ~~Y~r -- - -
NAME (PRINT)
SIGNATURE ~