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1. lA, 'F1JLliIIIA'ME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFADAVIT, UCENSE and
CERTIFICATE OF
MARRIAGE
FROM 1HE GROOM
II1IRST 'Wlfll'erio Se~, SURNAME
~IAI~"'U: ftUMtll:R
(THIS SPACE FOR STATE USE ONLY)
COlMV Dutchess
0liIV:r.rawN Wappinger
I~= 1368
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11. A RILL NAME
o SUPPLEMENTAL FILE
FROM THE BRIDE
MaFia.&J-eurdes ~
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0..1
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5, IBllII1IIIlmME,i1F!IIlIRFE1lI8IlIT
C. SUlllNA'MEhml!SIlI iMMfiUAGE
~Ol'1I1Im1AL-SEEiIilEI/EIlISE;) 063-6~ n,,.. JJ
C, :srotlItLiSECl!IRmfiNl:JMllER ,-~ =--
:2. IRESlDOEfA Np-" V oft iJI. nllt,.hess
I(S'\\\IJ1;) ~
C. ICIBltt <t!lIIIE TII Imlr'D 1JlOWII/ ilY \1.lWlGE
:e1Ai' Wappinger!; Falls
10 SiI'l'IEEr iADIDIIIESS 6409 Princess Circle ~ 125QO :
E. lIS ESImBlIICE tNm!IlN IUlMIiI'S ilIlF rom';QR:1N!lCFII'l!lIiI WllJ.AGE'!rY' 'YES o !NO .
S. IA. AGE ~~ SB.MT€IlnFIIiIIRmH ~ / m1P / vJPS3
Ill. ICMAlD!IIlII3N!r
iA. 'l:ISl!JALlOOGlJF!AmlO1\I Quality Insllran~p- In~pp-ctor
lB. ~ OF lfNI'llJSlIIRY 'OR iBIlISlIf/ESS Mechtronics COil)
5. IP.LMEOFIBIR1IlH Ibegue, Colombia
1(011nt.>SWMiElfOlll_VIIFINl!)HJSA)
6. fiA1JIImIl
fA. lNi\'ME Bemard~ BflYlllIna
lB. OOlJIN1l!RY'mF!BIIillIIf.l, Colombia
71. MrJ1IiIllER
Iil. enmt:IiJ\ME jUAlDI!IlIlIAMe). IF D1FH:RelT
c. ~~~~SeReno
D. SOCIAL 8ECllRIlY HlJMBBR
12. 'RESIIlBICE" N1Mft1eFk B. QulMc33
C. CIIE!CK{JNE 0 em' 0 TOWN Q,/'VlUAGE
=ClfY WappiRgers Faile
D.smEiETllOOIIESS fNtng Princ~'~ Circle
ZIP. 12590
IE. IS 8EIlID8NCE wnHfN l.IMf1ll {)f crrv <lFIINCORPORATED IIJU.AGE? Ii" VES 0 NO
~ /23 ~ii~
13.A AGE 42
14. BIPJ.OYMEINT
38. DATE OF BIRTH
A. USlW.OCCilJPAllON Unemployed
a 'TYPE OF INDUSTRY OR BUSINESS
15. PJACEOFBJRnl ~~.~
16. FATHER
A NAME Jose Ricaurte
is. COlJNJRVOF9IRIH ECl,ador
'A. WlIImN IIiIAME Maria Serrano
!s. 'OOl!lN1rRYOF!lIIIrnlI'l, Colombia
I\IlilMB8RI(JFmIS~l'lIilIAGE 4
, 17. 1lI0ThIER
A MAIDsnWIE ~arja Amador
e. OOONlHVOF8IR1li Ecuador
.8. NUMBER OF THIS MARRIAGE 2
19. 'PREVlOUS ,MARRIAGES
A NUMBS'l OF PREIIIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1
DEATH
:23. 'SUBSORJBED.AND :SWORN 11'01
SIGNATl:JRE 'OF :roWN llIR 'OITh'
j T.'his ,Iicel'lse 'Slitthori2les itI!I ,m niBlfl ,in 'l\Iew\Y:orkState of the 'bride amd 'QlDl!Im named above by any .person authorized
'f'IEilaliOl'1s;l.iaw f;11 !to 'per/arm ,mlllTi. <Il8JIIlmanies lIIIiIlhin 'New '1t'otk:state. mlS UCENSE VALID 1IN NEW YORK STATE ONLY.
D 'If ;checked, ttbis ,license lis :ta ,be .used lOl'lly for '1Ii1e !plI1"pOBe <Of a second or ,subsequent 118lB1llony.
r-^-\ :24. 1rQWN cGlR lClTh' 'OLERK 25. A.SOLaINIZAllONPERlOD .BEGINS
'} 'NJl(ME(PRrN1')~O C. Ma~
{SEAL SIGNATURE. " c' "#'~~ DATE Ofi/:m"nnfi TIME MONTH YEAR MONTH YEAR
'-t-I ::~~GrC1r&1~S ush Rd. WaD~~E Falls, Ns!TE 12590 ZIP '01 :02: 06 21 2006 08 19 2006
~~~~':R~~,IQ)~O=N= 26. 'S01.:EMNIZATIClN J:ilCCURI'IED Zl. 1YPEOFCEREMONV 28. PlACE WHERE MARRIAGE OCCURRED
SOINS iNAMSD'JiBOllE ONirhIE ' M AY ! YEAR (() 0 REL.:IGllilUS 1 ~ 'ClllJL ''1'\ , II ~Q
'DA'TEAND -Ail' 'THE 'fIME AND .330 .1 A STATE NEW YORK B. COUNTY wrr..~--'
PL:AOE:INDICA:TED. / i PM' 0 9 o OTHER. SPECIFY C. LOCATION OF CEREMONY
L~-= 1!~,~..~/~:r,8,.,.. ~~~f, "",~l;",\Lrr..~I. =:::=","'",~UAGE""
SIGNAT:URE" .7 _.J ,DATE $;JI i ;lot.i{?; I1IAJ'\I"I . t~':.AI.? CAn r:
MAITf~Ea VOl R.. -Pt-. (j) t(PPr'~ FIJH.S ~tJ:it. /.).SCf'c> SPECIFY lMtf'vll\J ~ I "~
STRE!ET !:lTYffOWNSTATE ZIP
:SO. WITNESS TO-cI)'t10NY "'.t1 sm,31. WITNESS TO CEREMONY
NAME~PRINI'lD I -I f'7' teRNo NAME(PRINT) r::.DbI.4
~ '<.
'SIGNU.uIilE.
DOH.9B !(0712005)
I
I SIGNATURE.
