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~IAII: ut- NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseph Ramos
MIDDLE CURRENT SURNAME
COUNIY Dutchess
CIIYITOWN Wappinger
~~~~kc; 1 368 .
~~~I~~~R 1 00
1. A. FULL NAME
FIRST
ll.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 047-72-613.5
D. SOCIAL SECURITY NUMBER
2. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CIIY 0 TOWN ~ VILLAGE
~~~CIFY WappinQers Falls
D. STREET ADDRESS 6316 Princess Circle ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? dYES 0 NO
03 / 09 / 1971
MONTH DAY YEAR
3. A. AGE 35
3B. DATE OF BIRTH
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4. EMPLOYMENT
A. USUAL OCCUPATION HiQhwav Maintenance
B. TYPE OF INDUSTRY OR BUSINESS DOT
5. PLACE OF BIRTH Bronx, New York
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Antonio Ramos
B. COUNTRY OF BIRTH Puerto Rico
7. MOTHER
A. MAIDEN NAME Maria Pacheco
B. COUNTRY OF BIRTH Puerto Rico
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
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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 ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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1ST
2ND
3RD
4TH
I duly swear/affirm, depose a
as to my right to enter into th
21. SIGNATURE OF GROOM~'
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
st of my knowledge and belief that the information I provided is true and
o 0
o 0
o 0
o 0
impediment exists
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Carolina Varqas
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Ramos
(OPTIONAL - SEE REVERSE) 594-39-0365
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. Florida B Miami IDade
(STATIil (COUNTY)
C. CHECK ONE [!f CIIY 0 TOWN 0 VILLAGE
~~~CIFY Miami
D. STREET ADDRESS ~~~~ S W 123rd Court Apt.
33186
ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 6 YES 0 NO
13. A. AGE 29 3B. DATE OF BIRTH 07 /28 ",.1976
DAY YEAR
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Broadcasting Operator
B. IYPE OF INDUSTRY OR BUSINESS H B 0 Latin America
15. PLACE OF BIRTH Dominican Republic
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Marcelino Vargas
'B. COUNTRY OF BIRTH Dominican Republic
17. MOTHER
A. MAIDEN NAME Flerida Martinez
B. COUNTRY OF BIRTH Dominican Republic
1
1 B. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV8RCE CIVIL AN(YLMENT
DE.[fH
B. HOW DID 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, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
23. SUBSCRIBED AND SWORN TOI FFIR ED
SIGNATURE OF TOWN OR CI CLE K"
This license authorizes the arriage in New York State of the bride and groom named above by any person authorized
Relations Law ~11 to periorm marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o " checked, this license is to be used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CIIYJCI,I:RK C M t 25 A SOLEMNIZATION PERIOD BEGINS
on . as erson . .
NAME (PRINT)
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{ SEAL }
'-..t-I
by New York Domestic
TIME
SIGNATURE ..
MAI~ fWCM~b
07/18/200
DATE
appinger Falls, NY 12590
16 2006
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
OATE AND AT THE TIME AND
PLACE INDICATED.
CITYITOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
I
STATE
27. IYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
1~VIL
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY ~{l~-lu.'iS
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY tA \. t(' IA ~ ~ r
29. OFFICIANT
NAME (PRINT)
STATE
MONTH
YEAR
MONTH
YEAR
ZIP
AM
04:16pM
07
19
2006
09
NAME (PRINT)
SIGNATURE"