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COUNTYDutehess
CITYfTOWN Wappinger
~~~~~~T1368
~~~~l~~ 1
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Norberto Aquino, Jr.
MIDDLE CURRENT SURNAME
CURRENT SURNAME
I
STATE FilE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Nicole Danielle Wood
~
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
MIDDLE
Q.
'"
B. BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME1t DIFfERENT
C. SURNAME AFTER MARRIAGI!' ~q U I no
(OPTIONAL - SEE REVERS{)66-64-3523
D. SOCIAL mURITY NUMBER p
utcness
12. RESIDENCE . .
(STATE) " (COUNTY)
C. CHECJfi ,0 CITY c:J mWN 0 VILLAGE
AND appmgers railS
SPECI 23 MarKet St A t
D. STREET ADDRESS ' P
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSElj 41-62 -5008
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOW,(O VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDREss23 Market St; Apt 1 ZIP 12b~U
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ....0 YES 0 NO
01 /01 /1974
MONTH DA V VEAR
12590
!)P
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORA1~ VILLAGEj,6 0
13. A. AG~O 3B. DATE OF BIRTH
MONTH DA V
14. EMPLOYMENT d' I R t" t
Me lea eeep lonls
A. USUAL OCCUPATIONw-,: M d I F lilt
e Ica ac
B. TYPE OF IN~TRY OIl./3\.lSINESS N Y
oum vernon Y
15. PLACE OF BIRT '
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A ~regory Roger Wood Sr,
A. N ME"::: S A
'B. COUNTRY OF BIRT~
3. A. AGE36
Yj!l9gNO
VEAR
3B. DATE OF BIRTH
...
:>
4. EMPLOYMENT
A. USUAL OCCUPATION Warehouse Worker
B. TYPE OF INDUSTRY OR BUSINESS Plumbing Supply
5. PLACE OF B1RTHSomerville, Nj
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Norberto Aquino
B. COUNTRY OF BIRTH Puerto Rico
7. MOTHER
A. MAIDEN NAME Judith Ramirez
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
o 0
DO"TH
17. MOTHER R b' G I d
o In ar an
A. MAIDEN NAME A
B. COUNTRY OF BIRT~ ~ I
1B. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
~VORCE CIVIL ~NULMENT
D1bATH
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
C. DATE LAST MARRIAGE ENDED?
MONTH DAV
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, DAV, YEAR) (CITY/COUNTY, STATE/COUNTRV, IF NOT USA) SELF SPOUSE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. ~- VEAR
MONTH DA V VEAR
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) (CITYICOUNTY, STATE/COUNTRV, IF NOT USA) SELF SPOUSE
o
o
o 1~ 0 0
o 2ND 0 0
o ~D 0 0
o 0 4TH 0 0
edge and belief that the information I provided is true and th~t I declare that no leg~~ediment eXists
". 22.SIGNATUREOFBRIDE~ --#~ ~&>~
USE CiJRRENT NAME 06/08/201 0
DATE
by New York Domestic
USE
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY 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
n
YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
08 07 2010
1~
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~'-I it~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF rt"vILLAGE OF
SPECIFY W A-P{J ,;;I tJC.S, Iii6
1I.Y.
NAME (PRINT)
SIGNATURE~
ZIP
31. WITNESS TO CEREMO~
NAME (PRINT):tJ.d ~
C1:1r.:.~IATIIDI:'''''. ~ ~ ~!