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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Carlos Alberto Vinas
FIRST MIDDLE
5TAfErfLt NUMDcn
(THIS SPACE FOR STA TE USE ONL Y)
COUNTY Dutchess
CITyrrOWN Wappinger
~~~~k9,T 1368
~5~I~J~R 21
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
11. A FULL NAME Darlene Ann Herrera
FIRST MIDDLE
B BIRTH NAME {MAIDEN NAME), IF DIFFERENT San70
C. SURNAME AFTER MARRIAGE Herrera - Vina~
D. Sci~I~~I~~;ULR;T;E~U~~~~RSE) 132-60-5843
12. RESIDENCEA.New York B Dutche~s
(STATE) (COUNTY)
c. CHECK ONE 0 CITY I!l' TOWN 0 VILLAGE
~~~CIFY Poughkeepsie
D STREET ADDREss82 Cardinal Drive
CURRENT SURNAME
CURRENT SURNAME
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N
B BIRTH NAME, IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)113-84-1811
o SOCIAL SECURITY NUMBER -
2 RESIDENCE A. New York B Oranae
(ST !'.JE) (couN'tfj
C. CHECK ONE "D CITY 0 TOWN 0 VILLAGE
~~~CIFY Newburah
o STREET ADDRESS 22 Farrell St., Apt. 1 L ZIP 12550
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIllAGE? ~ YES 0 NO
10 /n? /1968
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Homemaker
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH North Tarrvtown, New York
(CITY, STATE/C~RY IF NOT USA)
16. FATHER
A. NAME Thomas J Sanzo
8. COUNTRY OF BIRT~ S A
17. MOTHER
A. MAIDEN NAME Philomena M I nha~~o
8. COUNTRY OF BIRTJJ S A
18. NUMBER OF THIS MARRIAGE 3
ZIP 12601
o YES~ NO
1S'6:?
YEAR
3 A AGE37
3B. DATE OF BIRTH
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE4.~ 13.8. DATE OF BIRTH 1:? -D1
MONTH DAY
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4. EMPLOYMENT
A. USUAL OCCUPATION Maintenance
8. TYPE OF INDUSTRY OR BUSINESS Mahopac Nafl. Bank
5 PLACE OF BIRTH Santo Dominao, Dominican Republic
(CITY, STATE/COUNTRY IF NOT USA)
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6. FATHER
A. NAME Lorrenzo Vinas Alvares
8. COUNTRY OF BIRTH Dominican Republic
7. MOTHER
A MAIDEN NAME Martha Evangelina Vinas De Vina~
8. COUNTRY OF BIRTH Dominican Republic
8. NUMBER OF THIS MARRIAGE 2
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9. PREVIOUS MARRIAGES 19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH DIVORCE CIVIL ANNULMENT DEATH
1 001 0 1
8. HOW DID LAST MARRIAGE END? (3) ri DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) cr'DEATH
C DATE LAST MARRIAGE ENDED? 12 / 16 / 2004 c. DATE LAST MARRIAGE ENDED? 12 / 09 /2000
MONTH DAY YEAR MONTH _,/JAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? t1 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES rJ NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY,IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 12116/2004 Winnebago, Illinois r1 0 1ST 02101/1995 White Plains New York rJ 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I, being duly sworn, depose and sa , t y 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 mar A r
21. SIGNATURE OF GROOM ~ . (/ ~ . 22. SIGNATURE OF BRIDE ~ ()c.v~.QJl\Q. ~ \Aw~')C\
USE CURRENT NAME
~ DATE 03/22/2006
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23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of 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
{ } NAME (PRINT) Joh C. Masterson
TIME MONTH YEAR
SEAL SIGNATURE ~ . DATE 03/2212006
'-- -.J M>,}lIJ/'lQ NJI)~fj,~S
--v- OlU MIOOII er Falls NY 12590
STREET C /TOWN STATE
~~~R~~~R;~~~ IO~O~~~Ni,Z:~ 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 KJ CIVIL
~~l~E~~glc^:T;~E TIME AND ~"61i~ 04 07 2006 90 OTHER, SPECIFY
05
21 2006
by New York Domestic
25.8. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
DAY
YEAR
AM 03
06 :59 PM
23
2006
ZIP
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNT"westchest
29 OFFICIANT Daniel A'"1IE' rthy
NAME (PRINT) ,. =
SIGNATURE ~ -,;
MAILING ADDRESS p.
1Heady Street, Cortlandt
STREET CITYrrOWN
30. WITNESS TO CEREMONY
NAME (PRINT) !f1~~a
SIGNATURE ~ '~
DOH-98 (11/98)
TITLETown Justice
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF}b TOWN OF 0
VILLAGE OF
4-7-06
Cortlandt Manor
DATE
SPECIFY
Manor, New York 10567
STATE
NAME (PRINT)
SIGNATURE ~
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