050
ST A TE OF NEW YORK I STATE FILE NUMBER I
COUNTY Dutchess (THIS SPACE FOR STA TE USE ONL Y)
CITY;OWN Wappinger DEPARTMENT OF HEALTH ,itj~t . /1
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~~~~kCRT 1368 AFFIDA VIT, LICENSE and
~~~~~~R 50 CERTIFICA TE OF
MARRIAGE Lo SUPPLEMENTAL FILE ~
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A. FULL NAME
FROM THE GROOM
Cristian Docu
FIRST MIDDLE CURRENT SURNAME
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B BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 003-82-8172
o SOCIAL SECURITY NUMBER
2 RESIDENCE A. N Y B. Dutchess
(STATE) ~ (COUNTY)
C CHECK ONE 0 CITY LT TOWN 0 VILLAGE
~~~CIFY Wappinger
o STREET ADDRESS 607 Chelsea Cay
12590
ZIP
11 A. FULL NAME
FROM THE BRIDE
Marisa Rosa Salcedo Galvan
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Docu
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12 RESIDENCE ANY
(STATE) J
C. CHECK ONE 0 CITY 0 '10WN 0
~~~CIFY Wappinger
o STREET ADDRESS 607 Chelsea Cay
B. Dutchess
(COUNTY)
VI LLAGE
ZIP 12590
3 A
AGE 30
38. DATE OF BIRTH
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ct' NO E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES if NO
05 / 07 / 197 13 A. AGE 39 13BDATEOFBIRTH 01 / 19 /1963
MONTH DAY YEAR
YEAR
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNA TURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York Stat of the bride and groom named above by any person authorized
Relations Law S11 to perform marriage ceremonies within New 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 CLER,K 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) I fJa J.
{TIME MONTH
SEAL SIGNATU~~ - DATE 05/02/200
'-y-I ~T:'~~tf&ebus d, W p~~~~~r Falls, ~~E 12590 ZIP 10:1~~ 05
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE TIME MO DA Y YEAR
gtI~E ~~g'C"ZT;~E TIME AND 0
4. EMPLOYMENT
A. USUAL OCCUPATION Engineer
B TYPE OF INDUSTRY OR BUSINESS IBM Corp.
5 PLACE OF BIRTH Bucharest, Romania
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
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A. NAME Mike Docu
B. COUNTRY OF BIRTH Romania
7 MOTHER
A. MAIDEN NAME loana Bunescu
B. COUNTRY OF BIRTH Romania
8 NUMBER OF THIS MARRIAGE 2
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9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
.;
B HOW 010 LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C DATE LAST MARRIAGE ENDED? 08/ 08 / 2001
MONTH .; DA Y
D. ARE ANY FORMER SPOUSEIS) ALIVE? 0 'rES 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
1ST 08/08/2001 Danbury, Connecticut 0..... 0
2ND 0 0
o 0
DEATH
o
YEAR
3RD
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RELIGIOUS
OTHER, SPECIFY
29 OFFICIANT
NAME (PRINT)
SIGNATURE ~
DOH.98 (11/98)
MONTH
DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Student
B. TYPE OF INDUSTRY OR BUSINESS N C T C (college)
15. PLACE OF BIRTH Lima, Peru
(CITY, STATE'COUNTRY IF NOT USA)
16. FATHER
A. NAME Martin Felix Salcedo Arias
B. COUNTRY OF BIRTH Peru
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
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B. HOW 010 LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) [] DEATH
MONTH DA Y YEAR
D. ARE ANY FORMER SPOUSEIS) 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 [J
o 0
o 0
DATE
05/02/2002
by New York Domestic
28. PLACE WHERE MARRIAGE OCCURRED
1);yCIVIL
A STATE NEW YORK B. COUNTY":t>ltJt1k~
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
NAME (PRINT)
SIGNATURE ~