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Dutchess
COUNTY 0
Wappinger
CITY/TO\l/1II,
DISTRICT I ,)66
~~~I~~~R39
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM 0
Anthony N. AguIrre
~ I A I t: riLe I'IIUMtU::.M
(THIS SPACE FOR STA TE USE ONL Y)
11ft{
. /J
b'I/-t11
L D SUPPLEMENTAL FILE
FROM s~n.lf'~ijrley
~
1 A. FULL NAME
11. A. FULL NAME
CURRENT SURNAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
MIDDLE
(L
N
B BIRTH NAME. IF DIFFERENT
B BIRTH NAME (MAIDEN NAME), Ii DIFFIiAENT
AguIrre
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE:ll45-14-3155
D SOCIAL S~RITY N~BER Out h
12 RESIDENCE A. ew ersey B cess
(STATE)'" (COUNTY)
C ~H6CK CfirincefoRTY 0 TOWN 0 VILLAGE
SPECIFY 149 Pl:muf~ky ll:lflt: flB540
D STREET ADDRESS ZIP '"
E IS RE~NCE WITHIN LIMITS OF CITY OR INCORPORATEfig'-LAGE)4 0 Y~tO
13 A. AGE 13.B. DATE OF BIRTH __
MONTH DAY YEAR
C S~~~~~JNtLTE~~t:e~~SEJI7 9- 66-0846
D SOCIAL SE\;.~ITY NU1i'1BER UUI h
New Jersey clless
RESIDENCE A. (STATE)..1 B. (COUNTY)
C ~H6CK ofJrindilcfW 0 TOWN 0 VILLAGE
SPECIFY FlI k t
149 rl:lnofs y tint:
D STREET ADDRESS
D8MD
ZIP ~
Y/ffi1<J
YEAR
E IS RE~iJNCE WITHiN LIMITS OF CITY OR INCORPORA TEij'f"GE? 230
3 A AGE 3B. DATE OF BIRTH ,/0
MONTH DAY
4. EMPLOYMENT
14. EMPLOYMENT
Astronomer
A. USUAL OCCUPATION R h 1 n r
esearc os I U Ion
B TYPE OF INDI,ISTRY QR BUSltJESS C Uti I
LOS Angeles a om a
5. PLACE OF BIRTH !
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER A th A 0
n ony gUlrre
A. NAME A II
rgen ns
B. COUNTRY OF BIRTH
Teacher
A USUAL OCCUPATION Ate 01 Of n . 1
I S OUllel rlll\l;e 011
B. TYPE OF INDI"lE\TRY OR ilI,JSI!llE:S~ t. ut
NorwalK t,onnec IC
15. PLACE OF BIRTH '
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER Edward Hurley
A. NAME USA
B. COUNTRY OF BIRTH
7 MOTHER J. K
A. MAIDEN NAME amce oss
B COUNTRY OF BIRTH U S1 A
8 NUMBER OF THIS MARRIAGE
9 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL A~ULMENT
17. MOTHER
A. MAIDEN NAME Carol Hughes
USA
B. COUNTRY OF BIRTH I
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DbORCE CIVIL A~ULMENT
Dl1TH
D,fH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (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
MONTH DAY YEAR
D. ARc 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
1ST 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true a
as to my right to enter into the marr' e st te
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22. SIGNATURE OF BRIDE ~
21 SIGNATURE OF GROOM ~
A E ,04/19/2002
OAT
by New York Domestic
23
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{ SEAL }
'-v-I
TIME
MONTH
YEAR
04/19/2002
DATE
er Falls, NY 12590
AM 04
02:26 PM
ZIP
STATE
27 TYPE OF CEREMONY
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY PIA -fo~e.s.5
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
::J CITY OF t/ TOWN OF L VILLAGE OF
SPECIFY IIIl"i~~~e ea..v-~e~
pi-f.I15I7Nr vIJUE'j
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
1 D CIVIL
STATE
31
NAME (PRINTI
SIGNATURE ~
DOH.98 (11/9B)
NAME (PRINT)
SIGNATURE ~