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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
C'~rlDA P Naula
FIRST MIDDLE
COUNTY n.~
CITYITOWN \Nappl~
~~~~~C~ 136A
~G~~J~R 91
1. A.. FULL "NAME
CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) ~I /11
D. SOCII\L SECURITY NUMBER ,r. _
2. RESIDENCE A. NIut VorIc
~TtJ""
C. CHECK ONE 0 CITY ~ 'TOWN 0
AND '.A- .
SPECIFY VVIllPPnger
D. STREET ADDRESS 36 Kretch Circle ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
OR /?7 /1Q73
MONTH DAY YEAR
L 0 SUPPLEMENTAL FILE
B,O~
(COUN )
VILLAGE
3. A. AGE 31
3B. DATE OF BIRTH
FROM THE BRIDE
11, A, FULL NAME Christina J. Alvarez
FIRST MIDDLE
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT De Maria
c. SURNAME AFTER MARRIAGE De Maria - Naula
(OPTIONAL - SEE REVERSE)naa eA-3686
D. SOCIAL SECURITY NUMBER ~
12. RESIDENCEA.NlutVork B. Dutchess
~ATE) (COUNTY)
C. CHECK ONE 0 CITY r't TOWN 0 VILLAGE
AND We .
SPECIFY ppnoer
D. STREET ADDRESS 36 Kretch Circle
CURRENT SURNAME
ZIP 12590
o YES~ NO
1975
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 30 13.B. DATE OF BIRTH 03 ..0'1
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Housewife
B. TYPE OF INDUSTRY OR BUSINESS
15 PLACE OF BIRTH North T8ITYtoWn. New Vark
(CITY, STATE/COUNTRY IF NOT USA)
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16. FATHER
A. NAME John N. De Maria
B. COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME RIta Ann Quinn
B. COUNTRY OF BIRTHU SA
1B. NUMBER OF THIS MARRIAGE 2
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH
1 0 0
8. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT__~~ DEATH
C. DATE LAST MARRIAGE ENDED? 05 / 20 /~
MONT~ DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMA nON
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR)~Y, IF NOT USA) SELF SPOUSE
05l2Ol2OO5 esterchester County, N Y 0 r1
"
o 0
o 0
o 0
I impediment exists
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4. EMPLOYMENT
A. USUAL OCCUPATION I.JIndscapng
B. TYPE OF INDUSTRY OR BUSINESS M L C
5. PLACE OF BIRTH Victoria Del PoI18te. CUenca. Ecuec:tor
(CITY. STATE/COUNTRY IF NOT USA)
1ST
2ND
3RD
4TH
I, being duly sworn, depose and ,
as to my right to 'enter into the arria
21, SIGNATURE OF GROOM ~
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State f the bride and groom named above by any person authorized by New York Domestic
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.
{ ~ } ~:~~::I~~~CITY CLERC. M~ _ 25. ~I::LEMNI::::PERIOD BEG~:AR :OB}:6~~::~~I~~:::
SEAL SIGNATURE ~ ~ DATE 0811812005
'-v-I MA~~ Rd, pPngeI' Falls, NY 12590 10:05AM 08 19 2005 10 17 2005
STREET CITYfTOWN STATE ZIP PM
~~~R~~Ri~~~ IO~O~~~N~~E~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 ~IVIL
~~6E ~~glc^:T~~E TIME AND "AM
29, OFFICIANT
NAME (PRINT)
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B, COU~ ~ ~1$
LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF Pl(fOWN OF 0 VILLAGE OF
SPECIFY~f\ IL..D.\.€ r
6. FATHER
A. NAME Carlos HumbertD Naula
a. COUNTRY OF BIRTH Ecuador
7. MOTHER
A. MAIDEN NAME N8tI.vJdId ptnM
8. COUNTRY OF BIRTH Equador
8. NUMBER OF THIS MARRIAGE 1
9, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
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B. 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
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
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