121
+
.... I-
z :;
W
rJJ <t
W
m C
9 ii:
=>
0 I.L
:t:
rJJ <t
z
0
~
~
a
W
a:
W
Cl
<
a:
a:
<
:l!
...
0
~
()
ii:
~
W
()
W
a:
W a:
i W
rJJ
rJJ
W
a:
0 <
0
< Iii
~ W
13 ~
W
Q.
rJJ
+
~~~ W
2~l=
~,,;:5 I-
~ ~ ~ <t(..)
=>()W
:l!Cl5 ii:
5;~rJJ -
~~~ t:
lEorJJ W
0....>- (..)
Ii.illJ~
I-~LO
~g~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Daniel Quezada
MIDDLE CURRENT SURNAME
CtlUNTY Dutchess
CITYrrOWN Wappinger
~~J:~c: 1368 '
~5~~l~R 121
1. A. FULL NAME
FIRST
Q.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 060 84 6332
D. SOCIAL SECURITY NUMBER --
2. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C, CHECK ONE 0 CITY 0 TOWN 01 VILLAGE
~~CIFY Wappingers Falls
D. STREET ADDRESS 2651 East Main Street AptzlP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 011 YES 0 NO
3. A. AGE 34 3B, DATE OF BIRTH 03 / 16 / 197
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Deli Owner
B. TYPE OF INDUSTRY OR BUSINESS Delicatessen
5. PLACE OF BIRTH Ecuador
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Jose Quezada
B. COUNTRY OF BIRTH Ecuador
7. MOTHER
Deifilia Delgado
B. COUNTRY OF BIRTH Ecuador
1
8. NUMBER OF THIS MARRIAGE
A. MAIDEN NAME
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 DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULlLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, 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
Norma Torres Campos
MIDDLE CURRENT SURNAME
-1
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Quezada
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. Dutchess
(STATE) .-J (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN LJ'" VILLAGE
~~CIFY Wap~in~ers Falls
D. STREET ADDRESS 1 0 Prospect Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY DR INCORPORATED VILLAGE? d'" YES 0 NO
06 / 19 /1984
MONTH DAY YEAR
13. A. AGE 22
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Kitchen HelQ
B. TYPE OF INDUSTRY OR BUSINESS Hudson House Rest.
15. PLACE OF BIRTH Puebla, MeXICO
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Jose Tomas Torres Carcano
'B. COUNTRY OF BIRTH Mexico
17. MOTHER
A. MAIDEN NAME Julia Campos
B. COUNTRY OF BIRTH Mexico
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV'5CE CIVIL ANN~LMENT
DEAcr
(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 FOLlLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I duly swear/affirm, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the maga sta . 4
21. SIGNATURE OF GROOM f'? NATURE OF BRIDE~ ~/"A ~ ~
USECUR~AME 08/10/2006
DATE
e bride and groom named above by any person authorized
te. THIS LICENSE VALID IN NEW YORK STATE ONLY.
only for the purpose of a second or subsequent ceremony.
25. A. SOLEMNIZATION PERIOD BEGINS
DATE 08/10/200
inger Falls. NY 12590
STATE ZIP
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
W
en
z
W
(..)
:;
\O~
(!p. \M poS
by New York Domestic
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ~LAGE OF
PECIFY W~IM tlCl W
.
SIGNATURE.
ESTADOS UNIDOS MEXICANOS
'5STADO L1BRE Y SOBERANO DE PUEBLA
DIRECCION DEL REGISTRO DEL ESTADO CIVIL
No. DE CONTROL 02-1 U ~ U ~ b U
ENNOMBRE DEL EslADO I.IllR'll Y S()nU~^NO DE PUUBLA Y COMO
\.
ACTA DE NACIMIENTO
No. DE FOLIO 254820
DIRECTOR. . . .
DEL REGlSTRO
DEL ESTADO CIVIL DE L fiSTAOO..
~..- ---_.- -.. ..---- ......"...- ~.~. '."
CERTIFICO: QUE EN EL LIBRO
NUMBRO
15
DO NAClMJl!Nrps usl. A1)IO
1987
, EXISTE ASENTADA EL ACTA NUMERO
2890/
DE FBCBA
27 DE MAVO DE 1987
-_._",,-"._._~.-..~., ,- "-"'."-
LBVANTADAPORELJUIlZ LIC, JUAN JOSE 8ARRIENTOS GRANDA. .
LACU^LCONTlIlNELOSSIOUIIINTIlSJMTO~:_~_UZGAD.O..!!1..MERO. PUEBLA - . . . . . -
ACTA DE NACIMIENTO
OMBRE
N~RMA TORRES CAMPOS
-~ .-.----.
,
!.
FECBA DE NACIMInNTO ,
19 O( JUNIO DE 1984
BORA 00 : 00 : 00
CRIP
211140187028909
UGAR DE NACIMJBNTO
PUEBLA PUEBLA PUEBLA
.) .
FUE PRIlSENTADO
VIVO X
MUERTO.
SEXO :
MASCULINO
FEMENINO X
ECLARO
EL pAtlRE
LA MADRE
AMBOS
X
PERSONA DlSTINTA
PADRES
JOSE TOMAS TORRES CARCA~O
JULIA CAMPOS CAMA~
NACIONALIDAD
MEXICANA
NACIONALJDAD ME X I CANA
ABUEl.OS PATERt~OS Y MATERN OS
OMBRE
PEDRO TORRES JIMENEZ ...
ALTAGRACIA CAR~A~O MORALES
ROMAN CAMPOS RAMIREZ
/ \1
NACIONALIDAD /M Ex'II CANA)
I
\
OMBRE
<. ,,,,....
NACIONALIJ)'A!?' M EX 1 CA NA
/~
'NACIONALJDAD M EX I CANA
OMBRE
FLORENTINA CAM~.GO BURGOS
NACION'ALlDAD MEXICANA
\
TESTIGOS DEL ACTO i
OMDRE REBECA LOPEZ ARMAS . . . . . . . . .
. . . . . Y
CARMEN GO~EZ MARTINEZ
E
38
Y 35
Afloli, DE NACIONALIDAD
MEXICANA
Y
MEXICANA
.. ~ /_.~, ~ 4 . . . a ~
ARENTESCO NINGUNO . ~ . . . . . - - . ... - y NINGUNO
"\" "
OMBRE pE LA PERSONA/DISTINTA Oil LOS PADRES QUE DBCLARO BL NACIMI~NTO
.. .. ~ .. . - .. . . .. ~ .. ~ . . .. ....... . . . . . .. - . . .
(
NACIONALIDAD '".... - - . . . . . .
/
STA ACTA TIBNE LAS SIGUIBNTIlS ANOl'ACIONBS:
IN ANOTACION ALGUNA EN EL LIBRO DUPLICADO.'
/
\
Ill. DIA
03
DE
'*'
I
I
, ,
I
E COJ>.FORMIDAD CON LO PRnSCRI":'O""jji.iUj'SARTICULOS 848 Y 849 DEL CODIGO CIVIL. SE ID(PIDE LA
RESENTE CERTIFICACION BN nXTRACTO, IlN P U E B LA . I - . . . .'. . . .
=-. .
\
\
~.!tQL1J!1..L(U~ ~LLHJ1C H EA. . . . . . !
NDMI.lIW "
\! DEL illiGISTRO DE~
CfVIL DEL ESTADO
'HIVO ESTt-WAL
ER RTAW1f=,;\JTO DE
RVIC O~ f\L CIUDADANO
l!BLA, PUE
, I
,I
I
I
~ (J m f? > 0 ("") m 0 Z ,.... "< I""l ""' ~
m
~ ;; 00 :'=' ;; ::;' 0 ~ 0- g g ~, ::>
is.; " G;e5 is.; " 8 o -'v, 0 ~ "
m :!' " " ~ g ~ 2. 9
, ~ '" " '" " ::r ~
~ 0- 5; Vl(J 0- 5,'
n " " ""
:E ::> Vl_ ::> (ll _. ""' :::J _.
m ." mt- 8g'80-'" R-
." ;;; > it ;r 00 ;r
'" g 0... ~\ ~ O..c
~ ." > 0- 0-
'" > ." 2 " C 0 ~ ~n~~~t::
m '" 0 ..,
." a '" ~ ~ ...,m ~ ::l: C .., C .., r'b
0 ;;j :;' -t- :;' 5. ~ ~ ~ ~ !!-
'" ~::J
>-i '" 1;: if ": '"
..., , '" ,., -,
m >-i t- ~ ..., 'U . ~ f""l I""t
'" ;;; <: ~ " > ::!- ~ ~_5\'E.
>-i ;:;;
<: > ~ ", 6 ~ ~ 0 ~
<: t: 0' 0' .., ..,
> ~ tI ::> > ::> :0 '" ... 0-0-
s: 8 0 ,;;. 0 ~ '" '" "
~ 0 r::'g ::!-"
'" ." '"
r;; ." ~ 'U" "
0 ~ ::r:: ..g 8 ~ ~ ~
." '" 0 _...., :::;) 0
0 ~ 9 g ~ E:]
~ >-i '" t-
o ';;' 0 c.c.~
>-i n tI 0 m '" 0\ O\:::J ~
"
0 0 0 ~ ~ 'U ::> ::> 0 0
c: c: '" en
'" z .... c1:!O- ::l
." ;;l s; Q. 1; " " -,8 "
> " ~g.;g.an
-< IT! ."
'" > t 0 ~ '" 8 ;.J'.g
;;;
m G; ~. g ~\ 0 (b'
V> e; 3 n'? f3
Vl
Vl " 0-'"
.., '" 0-
:0 nOn n
_.r....._.._,...".__..__~~_~-._~___~~"'~_________--...,.......---'.."'"
PA5APORTE
PASSPlJRT
PASSEPORT
ESTA,OO'S UNIOOS MEXICANOS
6~~~~~1 P
Clave'ool pals de-expediciOn/COde ol,issuing
Stal,/Code du pays emelteur ME X
p,sapoer ~8"S~~N~/~oi~'bseport
Apellidos/SurnamelNom
TOUES
CAMPOS
Nombr8s/Given nameslPrenoms
;NORMA
Nacionaljoadl Nationality I Nalionahle
MEXICANA
CURPlPersooal No. !No. personnel
F;C~injCjueNor~e~ !4Da1e de naissance
Sexa/Sex/ Sexe
F
~~9,?r o~naCjmjenlo/PtaC~:~!blnh/Ueu de naissance
Pl..I.E III LA, P UE.
Fecha eX]H!dmion/ Date,::O!IIS,sue<Datedectelivrance
31/MAYl,2006
~~ 1MiAdyEt~tl~ ~!e1Date d expiration
~ut~rjdadIAUlhOftlVc6:~U;lor-~
NUEVAYOKK
Observaciones/ Remarks/Observations
P<MEXTORRES<CAMPOS<<NORMA<<<<<<<<<<<<<<<<<<<
8741842309MEX8406192F1105315<<<<<<<<<<<<<<<O