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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Ad~E Troy Wa&~ SURNAME
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
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) J~ C"~n
{ SEAL SIGNATURE~ C-~ DATE 09/30/201 TIME MONTH YEAR MONTH DAY
MAILING ADDRESS 11 "55AM
'-v-I 20 Middle ush Rd. Waooingers Falls. NY 12590 . 10 01 2010 11 29 2010
STREET CITYITOWN STATE ZIP PM
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 VIL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
COUNTY Dutchess
CITYfTOWN Wappinger
~~J~~C: 1368
~5~1~~~R 134
1 . A. FULL NAME
FIRST
Q.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 1 0~-Rn-fi4n 1
2. RESIDENCE A. NXTATE) B. Qe~ess
C. CHECK ONE 0 CITY It'I TOWN 0 VILLAGE
AND IAI .
SPECIFY vv app1nOj:!r
D STREET ADDRESS ?n Chel~ea Ridge Dr' Apt DIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES!i"'l NO
3. A. AGE 28 3B. DATE OF BiRTH MO~~ / J:3 / yl~82
4. EMPLOYMENT
A. USUAL OCCUPATION Steam Fitter
B. TYPE OF INDUSTRY OR BUSINESS Cnn~tn Ir.tinn
5. PLACE OF BIRTH Qllj:!j:!ns Nj:!w Ynrk
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME John E waddell
B. COUNTRY OF BIRTH I I S A
7. MOTHER
A. MAIDEN NAME Mir.hj:!lj:! Smith
B. COUNTRY OF BIRTH I I S A
8. 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
1ST
2ND
3RD
USE CURRENT
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
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29. OFFICIANT
NAME (PRINT)
I
STATE FILE NUMBER
(TH/S SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Stephanie I \Inn Alvare7
MIDDLE S CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE W::l r1dj:!1I
(OPTIONAL - SEE REVERSEr.:077 72 0936
D. SOCIAL SECURITY NUMBER ___ - __ - ____
12. RESIDENCE A. NY 8. nlltr.he~~
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D. STREET ADDRESS 26 Chelsea Rid<Je Dr: Apt D ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES /'1 NO
/04 A~R1
DAY YEAR
13. A. AGE 29
14. EMPLOYMENT
A. USUAL OCCUPATION Rank Teller
B. TYPE OF INDUSTRY OR BUSINESS Banking
15. PLACE OF BIRTH Brooklvn, New York
(CITY, STATEtt COUNTRY IF NOT USA)
16. FATHER
A. NAME Wilfrerln Alvare7 Jr
'B. COUNTRY OF BIRTH USA
13B.DATE OF BIRTH
07
MONTH
17. MOTHER
A. MAIDEN NAME Mildred Betancourt
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 1
19. 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 (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 ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o
o
o
1ST
2ND
3RD
o
o
o
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY IZ rNlvn
I C!Uz..-
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LAGE OF
SPECIFY Ct;i./) S;P~'/I16;
NAME (PRINT)
SIGNATURE~