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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFADAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM'. . ',' .
William Alvarado
COUNTY Dutcluss
CITYfTOWN wappinger
DISTRICT 1388
NUMBER
Ff"GISTER 133
NUMBER
1. A. FULL NAME
MIDDLE
CURRENT SURNAME
FIRST
11.
N
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE) 134-60-3364
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York . B. Dutchess
(STAT~ (COUNTY)
C. CHECK ONE IT CITY 0 TOWN 0 VIt:LAGE
AND Pough~
SPECIFY --'-'"
D. STREET ADDRESS 31 NOI1h Clover street
ZIP 12501
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r1 NO
12 / 05 / 1
MONTH DAY YEAR
3. A. AGE 29
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Federal Technician
B. TYPE OF INDUSlr ORBUSINfli~__ Mllltlry
5. PLACE OF BIRTH _con. NeW York
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
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A. NAME Angel Alvarado
B. COUNTRY OF BIRTH PuertO RICO
7. MOTHER
A. MAIDEN NAME Provldenda Quintana
B. COUNTRY OF BIRTH Puerto Rico
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVO'BE CIVil ANN~ENT
DE.A B'
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, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
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21. SIGNATURE OF GROOM ~
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STRE
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29. OFFICIANT
NAME (PRINT)
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kristine V. Mayers
MIDDLE CURRENT SURNAME
11. A. FUll NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Alvarado
(OPTIONAL - SEE REVERSE) 051-64-3993
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B. DutcheB8
(STATi}# (COUNTY)
C. CHECK ONE []'" CITY 0 TOWN 0 VilLAGE
D. :~;AD::1'1~eClover Street ZIP 12501
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES cti NO
11 /09 /1979
MONTH DAY YEAR
13. A. AGE 23
13.B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Domestic Engineer
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Poughkeepsie. New York
(CITY. STATEICOUNTAY IF NOT USA)
16. FATHER
A. NAME Alfred Thorn. Mayers
B. COUNTRY OF BIRTH U 8 A
17. MOTHER
A. MAIDEN NAME Amelia Ruth Mac L.eod
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVCC)CE CIVIL ANN~LMENT
DEAO
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
MONTH DAY YEAA
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, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
YEAR
l~CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY:t>u~~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
SPECIFY
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