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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Brent Matthew lieber
I"
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Yi
COUNTY Dutchess
CITYIT9WN Wappinger
DISTRICT 1368
, NUMBER
REGISTER 12
NUMBER
L 0 SUPPLEMENTAL FILE
11. A.
FROM THE BRIDE
FULL NAME Maribel Mendoza
FIRST MIDDLE
CURRENT SURNAME
FIRST
MIDDLE
CURRENT SURNAME
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B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE lieber
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA.NewYOrk
(STATE) J
C. CHECK ONE Q CITY ~ TOWN
~~CIFY WaPPInger
D. STREET ADDRESS 12 Alpine DrIve Apt. C
ZIP 12590
o YES~ NO
1.981
YEAR
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE.
(OPTIONAL. SEE REVERSE)17D-58-4085
D. SOCIAL SEC~~ITY NU~ilER
2. RESIDENCE A, New york B. Dutchess
(STATE) Ii (COUNTY)
c. CHECK ONWa D. CITY 0 TOWN 0 VILLAGE
~~~CIFY PPlnger
D. STREET ADDRESS 12 Alpine Ortve ApE. C ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3. A. AGE 34 3B. DATE OF BIRTH 05 /29 /1971
MONTH DAY YEAR
B. Dutchess
(COUNTY)
o VILLAGE
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE24 13.B. DATE OF BIRTH 11 .29
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Unemployed
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Puebla, Mexico
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Jose Antonio Mendoza
B. COUNTRY OF BIRTJv1ex1co
17. MOTHER -
A. MAIDEN NAME Ada leticia Nunez
B, COUNTRY OFBIRTtMexlco
1B. NUMBER OF THIS MARRIAGE 1
19, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
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4. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDU~fl!.orhOg&ES~ Kennedy C8thollC H S
5. PLACE OF BIRTH \.AIYa , ohio
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
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A. NAME Joseph Michael lieber, Sr.
B. COUNTRY OF BIRTH U 5 A
7. MOTHER
A. MAIDEN NAME Martha Jane Bowman
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVifCE CIVIL ANBULMENT
DEATH
o
8. HOW 010 LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
8. 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
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY,IF NOT USA) SELF SPOUSE
o 0
o 0
o 0
o 0
that no legal impediment exists
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1ST 0 0 1ST
2ND 0 0 2ND
~ 0 0 ~
~ 0 0 ~
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I de lar
as to my right to enter intD the marriage state. -
21. SIGNATURE OF GROOM ~
2. SIGNATURE OF BRIDE ~
23. SUBSCRIBED AND SWORN TO BEFORE ME 02/21/2006
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within w York State, THIS LICENSE VALID IN NEW YORK STATE ONLY,
o If checked, this license is to e used only for the purpose of a second or subsequent ceremony.
24. TOWN OR CI E~. 25, A, SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
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{ SEAL }
'-v-'
YEAR
MONTH
YEAR
TIME
MONTH
DATE02/21l2OO6
h Rd, Wappnger Falls, NY 12590
CITYfTOWN STATE
26. SOLEMNIZATION OCCURRED 27, TYPE OF CEI'IEMONY
TIME MO. DAY YEAR 0 0 RELIGIOUS
0:43 AM
PM 02
2006
04
22 2006
22
ZIP
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYf.J(/rr'/I~"
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ;B( TOWN OF 0 VILLAGE OF
SPECIFY !d&(JII'/8-GI<..-
1~CIVIL
9 0 OTHER, SPECIFY
29. OFFICIANT
NAME (PRINT)
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Estados Unidos Mexicanos
llpo Cleve del pals de expedici6n P/!S8porte No.
c:=- P =--=-o:::- HEX No' 05210004400
" Apellldos ,_........
~.MENDOZA NUNEZ
Nombres IGtwn--'PNrars -"'~
MldUBEL' ~-
NecionaIidad ,__ -,.!\
;HEXICANA, -.~
;:,i"("Feche de nec:imlento ".....__..:,.C
: ~~,29 11 1981 . ,
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wSexo '&.1'- Lugar de naarTiento J....dbifhlUlu.......
if{3 PUEBLA, PUE.
ff?lJ:eche expedici6n ,....--..- ~-~
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. '04 02 2010 PUEBLA ~. .
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No.JND~
129MPLNXROO
P<MEX~ENDOZA<NUNEZ<<MARIBEL<<<<<<<<<<<<<<<<<
2100044009MEX8111292F1002045<<<<<<<<<<<<<<08
.... ;..
, .,.-.--.
CHANCERY OFFICE
ARCHDIOCESE OF NEW YORK
I
February 2, 2006
Reverend James Teague
Kennedy Catholic High School
54 Route 138
Somers, NY 10589
Reverend and Dear Father Teague,
Enclosed please find a translation from Spanish ofthe Baptismal Certificate of
Maria Nunez, from the Archdiocesan Office of Hispanic Affairs.
I also enclose the original certificate that you forwarded to this office for
translation.
With kind regards, I am,
Sincerely in Christ,
St. _L~J) &I.t,_J
Reve~<6il~s J. Mathers, JD, .TCD
Vice Chancellor
.
~-4
HISPANIC AFFAIRS
ARCH DIOCESE OF NEW YORK
,
Baptismal Certificate Translation
Parish: Maria Reina
Name of Baptized:
Maribel Mendoza Nlulez
Date of Birth:
November 29, 1981
Ill: Puebla, Pue.
Legitimate Daugther of:
Jose Antonio Mendoza and of Ada Leticia
Nunez de Mendoza
Maribel Mendoza Nunez was baptized in this Parish on the of 6th March of 1982
Godfather:
Godmother: Genoveva Nunez Sabido
Fr. Margarito Robles
Pastor
I, Juan Lulio Blanchard, deposed and say:
That I have translated the above statement from Spanish into English.
That it is true and correct as my knowledge and belief.
1011 FIRST AVENUE, NEW YORK, N.Y. L0022 TEL: 212-17L-1.000 Ext. 2982