030
SIGNATURE ~ DATE 04/14/2010
MAILING ADDRESS
20 Middle ush Rd. Waooinoers Falls, NY 12590
STREET CITY/TOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER. .
SONS NAMED ABOVE ON THE TIME M. DAY YEAR 0 0 RELIGIOUS 1 NIL
DATE AND AT THE TIME AND
PLACE INDICA 9 0 OTHER, SPECIFY
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFADAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Silvio Marcelo Hernandez
MIDDLE CURRENT SURNAME
USE
23. SUBSCRIBED AND SWORN 01 IRMED BEFORE ME
SIGNATURE OF TOWN OR C CLERK ~
This license authorizes the marriage In New York State of the bride and groom named above by any person authorized
Relations Law ~11 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 CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) oh C. Maste son
COUNTY Dutchess
CITYfTOWN Wappinoer
~~~=~c: 1368 .
~5~~J~R 30
1. A. FUll. NAME
FIRST
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
..
f;j
B. BIRTH NAME, IF OIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSI;L____
D. SOCIAL SECURITY NUMBER xxx-xx-xxxx
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWNlItJ VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDRESS 72 1m perial Blvd: Apt 111 0 ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? "6 YES 0 NO
3. A. AGE~R 3B.DATEOFBiRTH 01 /31 /1974
MONTH DAY YEAR
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4. EMPLOYMENT
A. USUAL OCCUPATION Construction
B. TYPE OF INDUSTRY OR BUSINESS Construction
5. PLACE OF BIRTH Parque Del Plata. Uruauay
(CITY, STATE I COUNTRY IF NOT USA)
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6. FATHER
A. NAME Bernardo Hernandez
B. COUNTRY OF BIRTH Uruguay
7. MOTHER
A. MAIDEN NAME Lina Diaz
B. COUNTRY OF BIRTH Uruguay
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
SUPPLEMENTAL FILE
FROM THE BRIDE
Linda Patricia Fiorito
MIDDLE CURRENT SURNAME
11. A. FUll. NAME
FIRST
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
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I duly swear/affirm, aep'ose and say, that to
as to my right to enter into the marnage
o
o
o
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Fiorito-Hernandez
(OPTIONAL. SEE REVERSE1 00-62-9205
D. SOCIAL SECURITY NUMBER
12. RESIDENCE ANY BDutchess
(STATE) . J-. (COUNTY)
C. CHECK ONE 0 CITY 0 TOWWU VILLAGE
~~CIFYWappingers Falls
D. STREET ADDRES12 Imperial Blvd; Apt 1110 z,p12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ""0 YES 0 NO
.%7 )'968
DAY YEAR
13. A. AGe41
06
~
{ SEAL }
'-v-I
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATIONMassage Therapist
B. TYPE OF INDUSTRY OR BUSINESsMassage Therapy
15. PLACE OF BIRTHNew York, NY
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAMEJohn Joseph Fiorito
. B. COUNTRY OF BIRTJ.! S A
17. MOTHER
A. MAIDEN NAME Concetta Theresa Russo
B. COUNTRY OF BIRTJ-J S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.'~ YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
~
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY. STATElCOUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
that the information I provided is true an
o
o
o
DATE
by New York Domestic
TIME
MONTH
YEAR
MONTH
YEAR
AM 0
01 :36PM 4
06
13 2010
15
2010
28. PLACE WHERE MARRIAGE OCC~. _
A. STATE NEW YORK B. COUN~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LAG~. It 61
SPECIFY kJi+-PP I~~
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)--1~~NfllL)6 II ~ ~
RIANATIIRI=~ ~M1!A.A'" ~ A' ~~-"