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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
FIRST JasoMQD~achun C~~~E~T SURNAME
B, BIRTH NAME, IF DIFFERENT Kachun Cheng
COUNTY Dutchess
CITYITOWN Wappinger
~~J:~~T1368 .
~5~~J~R50
1. A. FULL NAME
11.
F:i
C, SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSElo-65 79-0222
0, SOCIAL SECURITY NUMBER :> -
2 RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C, CHECK ONE 0 CITYwtJ TOWN 0 VILLAGE
~~~CIFY Fishkill
D. STREET ADDRESS 2406 Rockledge Court ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CIlY OR INCORPORATED VILLAGE? 0 VESv'D NO
06 /29 /1977
MONTH DAY YEAR
3. A. AGE32
4. EMPLOYMENT
A. USUAL OCCUPATION Engineer
B, TYPE OF INDUSTRV OR BUSINESS Semiconductors
5. PLACE OF BIRTH Hono Kono
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A, NAME Stephen Yuk-Hoi Cheno
B. COUNTRY OF BIRTH Hono Kono
3B. DATE OF BIRTH
7, MOTHER
A. MAIDEN NAME Alice Oi-Lee Lui
B. COUNTRY OF BIRTH China
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH DA V 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
(MO/IITH, DAY, YEAR) (CITY/COUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Alicia Wang
MIDDLE
.J
11. A. FULL NAME
FIRST
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGECheng
(OPTIONAL. SEE REVERS"D11_76_8200
0, SOCIAL SECURITY NUMBER
12, RESIDENCE ANY put chess
(STATE).L. (COUNTY)
C. CHECK ONE R CITY'U TOWN 0 VILLAGE
AND 1=' hk"
SPECIF'I' _IS I
D. STREET ADDRESf406 Kockledge L;ourt
1lb~U
ZIP
v'..
o VEsD NO
)-983
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13, A. AG~6 3B. DATE OF BIRTH 12 ,28
MONTH DAY
14. EMPLOYMENT
A, USUAL OCCUPATIONEngineer
B. TYPE OF INDUSTRY OR BUSIN~SsManufactunng
15. PLACE OF BIRT~oston, MA
(CITY, STATE I COUNTRY IF NOT USA)
16, FATHER
A. NAMERobert Wang
'B. COUNTRY OF BIRTl aiwan
17. MOTHER
A. MAIDEN NAME Kit-Ling Yu
B. COUNTRY OF BIRT~hina
1B. NUMBER OF THIS MARRIAGE 1
19. ~~~~19~~RMtf~It~8us MARRIAGES WHICH ENDED BY
DOORCE CIVIL A~ULMENT
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
DtfTH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
,..- YEAR
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
o
o
o
22. SIGNATURE OF BRIDE.
1ST
2ND
3RD
4TH
I duly swear/affirm, depose and say,
as to my right to enter Into the mar
21. SIGNATURE OF GROOM.
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
of my knowledge and belief that the information I provided is true a
23. SUBSCRIBED AND SWORN 0
SIGNATURE OF TOWN OR C CLERK ~
This license authorizes the marriage in New Yo State of the bride and groom named above by any person authorized
Relations Law ~11 to perform marriage ceremonies within New York Slate. 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) John C. Masterson
TIME MONTH YEAR
SEAL SIGNATURE ~. DATE 05/10/2010
I.- -.J MAlklttG,.AP.I.DflEi~eS
-v- LU MIOOII sh Rd, Wappingers Falls, NY 12590
STREET ClTYrrOWN STATE ZIP
~~~RJ:RT~~J 10~0!r~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M . AY R o')t RELIGIOUS
~tl6E ~gIC~~J~E TIME AND AM t' 0 9 0 OTHER, SPECIFY
~~~t~~~~~ AN1>R6W Y. U-€
SIGNATURE~ ~ ~
MAILING ADDRESS
18 ~ RA-illtJutJ.,IJ V6 YTIT'TGN ISLAN'b .
STREET 'CITYITOWN
oow"""'~~~. N\. 5~... .
NAME (PRINT) '/;: 6~Q
SIGNATURE~ /r.
TITLE
DATE
NY
MONTH
YEAR
12:39~~ 05
2010
07
09 2010
11
10 CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYOtIf)1chestrr
J<.~ V &-I<..GN 2>
S/30//0
. /
/~3t)~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
(:!( CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY Ne.w ROt~(l1/ p i o?;Of
G-o 6lUA-~~ f<j'D6E M.)
STATE
ZIP
31. WITNESS TO CEREMONY
NAME(PRINT) J~~
SIGNATURE~