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::i SEAL SIGNATURE~ DATE 11/01/200
MAILING ADDRE
'-v-I 20 Mid er Falls NY 12590
STREET CITYITOWN STATE ZIP
~~~R~~RT~~J 'o~O~~~N~i~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M. DAY YEAR 0 ~IOUS 1 0 CIVIL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Alhp.rtn . I P.!=: I I!=: Alv~rp.7
MIDDLE CURRENT SURNAME
USE
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New State 0 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 C. M
COUNTY Dutchess
CITY/TOWN Waooinqer
~~~:~; 1368 '
~5~I~J~R 175
1 . A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 059-74-5683
2. RESIDENCE A. Np.w V nrk B. nlltr.hp.!=:!=:
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D. STREET ADDRESS 25D Alpine Drive
ZIP 12590
YES r!f NO
/ 1983
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
3. A. AGE ?~ 3B. DATE OF BIRTH O~ / 01
MONTH DAY
4. EMPLOYMENT
A. USUAL OCCUPATION S~les
B. TYPE OF INDUSTRY OR BUSINESS Plumbing
5. PLACE OF BIRTH Peekskill New York
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Migllp.1 Angp.ln Alv~rp.7
B. COUNTRY OF BIRTH Guatemala
7. MOTHER
A. MAIDEN NAME Ana F Cueva
B. COUNTRY OF BIRTH Ecuador
8. NUMBER OF THIS MARRIAGE 1
9. ~~~~~?RM6'FR~~~T8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
YEAR
MONTH DAY
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, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I duly swear/affirm, dep.ose and say, that t
as to my right to enter Into the marn
21. SIGNATURE OF GROOM~'
o
o
o
TITLE
DATE
NAME (PRINT)
SIGNATURE~
DOH-98 (0312006)
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L D SUPPLEMENTAL FILE
FROM THE BRIDE
Susan Elizabeth Pimentel
MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Alv~re7
(OPTIONAL - SEE REVERSE) 052 70 7756
D. SOCIAL SECURITY NUMBER --
12. RESIDENCE A. Np.w York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY []l'" TOWN 0 VILLAGE
AND W .
SPECIFY appmger
D. STREET ADDRESS 25D Alpine Drive ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES c1 NO
04 /08 /1983
MONTH DAY YEAR
13. A. AGE 23
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Architectural Designer
B. TYPE OF INDUSTRY OR BUSINESS Architecture
15. PLACE OF BIRTH White Plains. New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Edmundo Pimentel
'B. COUNTRY OF BIRTH Peru
17. MOTHER
A. MAIDEN NAME Maria Elena Iturbe
B. COUNTRY OF BIRTH Peru
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 010 LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
,-- YEAR
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) (CITY/COUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
o 0
o 0
o 0
o 0
o legal impediment exists
22. SIGNATURE OF BRIDE ~
DATE
11/01/2006
by New York Domestic
TIME
MONTH
YEAR
MONTH
YEAR
AM
06:17PM
2006
12
31 2006
11
02
~ .
;f, C'. l,f/€Sr
/f/II IbC:.
1~S5o
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY:beiJ'CHiiS>
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LAGE OF
SPECIFY W/fPfJ,IIIGF/?S r.4t.LS
ATE
NAME (PRINT)
SIGNATURE"