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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFADAVrr,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Joseph Anthony Martinez
FIRST MIDDLE
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
2 0 0 1 0 0
8. HOW DID LAST MARRIAGE END? (3)~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3)~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 09 / 27 /2005 C. DATE LAST MARRIAGE ENDED? 04 / is /?t'Il"t.t
MONT.tioI DAY YEAR MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? '(] YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATIONI
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
1 ST 01/1611997 pouahkeeDSie. Ny 0 ~ 1ST 0411~ st I ftui~, Mft ~ 0
2ND Q9fZl12OO5 pouahkeelJSie. Nv ~ 0 2ND 0 0
3~ 0 0 ~D 0 0
~H 0 0 ~H 0 0
I, being duly sworn, depose a that to the best of knowledge and belief that the information I provided is true and that I declare that no legal Imped~m t exfts
as to my right to enter into th marria ^ < ~ n ~ - Il \.l....
21. . SIGNATURE OF BRIDE ~ ~ lJ tJ Il M.J\() ~~
~SE CURRENT NAME
clATE O2I01I'2DD8
of the b ide and groom named above by any person authorized by New York Domestic
ew York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
e used only for the purpose of a second or subsequent ceremony.
25. A. SOLEMNIZATION PERIOD BEGINS
COUNTY Dutchess
CITYiTOWN ::PfAnoer
~~J:~c~ 1
REGISTER 6
NUMBER
1. A FULL NAME
CURRENT SURNAME
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B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)I:D'.) t:!? 1531
D. SOCIAL SECURITY NUMBER ~,-
2. RESIDENCE A. NY B. Dutchess
(STATE) J. (COUNTY)
C. CHECK ONE 0 CITY LI TOWN 0 VILLAGE
~~~CIFY Hyde Park
D STREET ADDRESS 52 PlnC'tvoodG Road ZIP 12538
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
01 /09 /1963
MONTH DAY YEAR
3. A. AGE 43
3B. DATE OF BIRTH
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4. EMPLOYMENT
A. USUAL OCCUPATION Accountant
B. TYPE OF INDUSTRY OR BUSINESS ~ Film
5. PLACE OF BIRTH Bronx. New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Ramon Antonio Martinez
B. COUNTRY OF BIRTH Santiago. Cube
7. MOTHER
A. MAIDEN NAME Carmen Valentin
8. COUNTRY OF BIRTH Manetl. PueI"tQ Rico
8. NUMBER OF THIS MARRIAGE 3
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(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. FULL NAME Alexandl1l FlIMlA I .-
FIRST MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE ~Arti~
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER 072-7o..71~
12. RESIDENCE A. NY B. nllt~q
(STATE) ~
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Hyde Park
D STREET ADDREss52 Plnewoods Roed ZIP 12538
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES.tJ NO
13. A. AGE28 13.B. DATE OF BIRTH f\Q .(2 1ft'T7
~NTH OAY 'WH-f'EAR
14. EMPLOYMENT
A. USUAL OCCUPATIONCuslomer Service
B. TYPE OF INDUSTRY OR BUSINESS TeI~munl~ftnS
15. PLACE OF BIRTHBrftmNllle. ~
(CITY, STATE/COUNtM IF NOT USA)
16. FATHER
A. NAMEJohn W I .M
B. COUNTRY OF BIRT~ S A
17. MOTHER
A. MAIDEN NAME Karen L Ambold
B. COUNTRY OF BIRTtU S A
18. NUMBER OF THIS MARRIAGE 2
DEATH
DATE02ID1I2OO6
YEAR
TIME
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
ZIP
1~
28. PLACE WHERE MAP.RIAGE OCCURRED
A. STATE NEW YORK B. COUNTyd;2~TtJil
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) ./'
o CITY OF 0 TOWN OF ~LLAGEr.. 11.
;P,CIFY ~Aif't#,4fA ~
NAME (PRINT) ,
SIGNATURE ~ '
DOH-98 (11/98)