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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Abel Esquivel
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
DISTRICT 1368 '
NUMBER
~~~~~~R 117
1 , A, FULL NAME
FIRST
B, BIRTH NAME, IF DIFFERENT
C, SURNAME AFTER MARRIAGE
(OPTIONAL" SEE REVERSE) 949-71-3473
0, SOCIAL SECURITY NUMBER
2, RESIDENCE A. New York B, Dutchess
(STATE) .J (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN L.:J VILLAGE
~~~CIFY WapQin~ers Falls
D. STREET ADDRESS 5607 Pnncess Circle ZIP 12590
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? dYES 0 NO
3. A. AGE 27 3B. DATE OF BIRTH 11 / 30 / 197
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Cook
B. TYPE OF INDUSTRY OR BUSINESS Chilis
5. PLACE OF BIRTH Altamirano, MeXICO
(CITY. STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Carmelo Esquivel
B. COUNTRY OF BIRTH MeXICO
7. MOTHER
Juana Avelino
A. MAIDEN NAME
MeXICO
B. COUNTRY OF BIRTH
1
8. NUMBER OF THIS MARF,lIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO~CE CIVIL ANN~LMENT
DEA(r
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
10. 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
III
2
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~
1ST
2ND
3RD
~
{ SEAL }
~
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
ir
I
Lo
~
SUPPLEMENTAL FILE
FROM THE BRIDE
Jennifer Slater
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. 81RTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Esquivel
(OPTIONAL" SEE REVERSE) 130-64-3631
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) ...J (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN LJ VILLAGE
~~CIFY Wappingers Falls
D. STREET ADDRESS 5607 Pnncess Circle ZIP 12b8U
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? cf YES 0 NO
13. A. AGE 32 3B. DATE OF BIRTH 07 / 04 /1974
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Waitress
B. TYPE OF INDUSIflY OR ~ljSINESS PerkinS Restaurant
15. PLACE OF BIRTH t-'ougnKeepsle, New York
(CITY. STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME James Joseph Slater
. B. COUNTRY OF BIRTH USA
17. MOTHER
A, MAIDEN NAME Nancy Patricia Lutz
B. COUNTRY OF BIRTH U ~ A
"I
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV8RCE CIVIL AN'tJ'LMENT
D~H
(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 FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CfTYICOUNTY. STATElCOUNTRY. IF NOT USA) SELF SPOUSE
o
o
o
1ST
2ND
3RD
o
o
D
by New York Domestic
TIME
MONTH
YEAR MONTH
YEAR
ZIP
01 :5~~
08 10 2006 10 08 2006
STATE
27. TYPE OF CEREMONY
O~IGIOUS
9 0 OTHER, SPECIFY
01,
TITLE
NAME (PRINT)
SIGNATURE~
hc'lH-AA Inv.>nMI
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY vult" j t'>~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF G TOWN OF ~ VILLAGE OF
SPECIFY tv Af.pl ~f~I'S fills
-f
SIGNATURE~