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~ I A I t: VI'"" NI:VV YUH~
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
t:.lfrj:)rllot:. Lawl:or:l IL
lM~ UE OU~RENTSURNAME
1ST 10/21/19S0 Middlesex Co., NQ.\.'I .Jersey ~
2ND 0
3RD 0
~H 0
, being duly swom, pose an say, that to t e best Ofoowe ge an
as to my right to enter into the marri e te. a
21. SIGNATURE OF GROOM ~
: USE CURRENT
23. SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOVVN 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 onl for the pu ose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
COUNTY n, ,t~hp.~~
CITYfTOWN \N;=Ippingpr
~~J:~~ 136R
~5~~J~R 11
1. A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SDCIALSECURITY NUMBER 134-38-7632
2. RESIDENCE A. N ;iATE) B. q~twss
C. CHECK ONE 0 CITY eI TOWN 0 VILLAGE
AND \AI .
SPECIFY V v applnger
D. STREET ADDRESS P 0 Roy 1 ~R ZIP 1?~ 1?
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES otI NO
3. A. AGE 53 3B. D~TE OF BIRTH ~ / Qj / .;ti49
4. EMPLOYMENT
A. USUAL OCCUPATION Recruiter
B. TYPE OF INDUSTRY OR BUSINESS Own ~llsinE's~
5. PLACE OF BIRTH ~~A~Y~ USA)
6. FATHER
'A. NAME A.lfred 4. Lawton, Sr
B. COUNTRY OF BIRTH I 1St:.
7. MOTHER
A. MAIDEN NAME Marion Mogl:lire
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o 0
B. HOW DID LAST MARRIAGE END? (3) I!!r DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 10 / ') 1 / 1 aao
MONTH o7f.if vm
D. ARE ANY FORMER SPOUSE(S) ALIVE? I!ifYES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
OATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1
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{ SEAL }
'-v-I
NAME (PRINT)
I
)
I CERTIFY THAT I SOLEMNIZEO
THE MARRIAGE OF THE PER'
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME ANO
PLACE INDICATED.
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
-.J
11. A. FULL NAME FIRST ~~~ra Colby CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Cruz Hinojosa
c. SURNAME AFTER MARRIAGE ~olb\J La\Aif:on
(OPTIONAL - SEE REVERSm-: J
D. SOCIAL SECURITY NUMBER 551-86-4473.
12. RESIDENCEA.N YSTATE) B. D'1~~S~
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND \AI .
SPECIFY v.Ji aprlngpr
D. STREET ADDRESS P 0 Rm( 1 ~A ZIP 1?~ 1 ?
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES!l NO
13. A. AGE51 13.B. DATE OF BIRTH &JiH /1tiy -1~a
14. EMPLOYMENT
A. USUAL OCCUPATION Recruiting
B. TYPE OF INDUSTRY OR BUSINESS 0\AJ.rl 811~'rll~~~
15. PLACE OF BIRTH~~, ~~ ;r~)
16. FATHER
A. NAME Manuel Hinojosa
B. COUNTRY OF BIRTHI J S t:.
17. MOTHER
A. MAIDEN NAME Soila De Luna
B. COUNTRY OF BIRTHlJ 5 /J.
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF OECREE PLACE ISSUEO AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o
o
YEAR
o
o
o
MONTH
YEAR
MONTH
YEAR
02
14
200304142003
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNT;)> I ~ l~ esS
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF )(TOWN OF 0 VILLAGE OF
SPECIFY~l U. ~ e ,r