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018 + o (j) Lt) Nw ......!< Iii -;; Z ~ !z as I- gjL.L. ~ l!i~ Q gQ) - ::oC)wl.L OC"I.L ~'a. ~ c( ~g-i ~~ ~ a .0 ll!~ l!l< c( ii:c !;io :;C/) ~E ~Q) (!jD:: g;..c ffi"5 uo ll!CI) W ' ~c.offi en,....~ fa 2 a: Q 8 ~ c( Ii; ?i: w &i ~ lL en w -0 Z -w (.) -::::i + ~~~ w ffi~~ I- ~ffiz c( en -' :; (.) ::ougw :llC) u: !zl!; - ~m~ ~ ito~ w ~~(!j (.) ~~lll OW zgl!; STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and CERTIFICATE OF MARRIAGE FROM THE GROOM Diego Leon Benitez-Conde FIRST MIDDLE CURRENT SURNAME 1 ST 0 0 1ST 0 0 2ND 0 0 2ND 0 0 3RD 0 0 3RD 0 0 4TH 0 0 4TH 0 0 I duly swear/affirm, depDse and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal Impediment exists as to my right to enter into the~arnage state. I 21. SIGNATURE OF GROOM. \J . wJs 2. SIGNATURE OF BRIDE. C),oraY}3. CZCjevC>. 23. SUBSCRIBED AND SWORN TOIAFFIRME BEFORE M:E CU USE CURRENT NAME 03/15/2010 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 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-.., 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS } NAME (PRINT) John C. Masterson {SEAL SIGNATURE.' DATE 03/15/2010 TIME MONTH YEAR MONTH '-v-I MA~5GlCWcfaf~ sh Rd, Wappingers Falls, NY 12590 03:31:~ 03 16 2010 05 STREET ClTYrrOWN STATE ZIP ~~~R~~RT~~J ~~O~~~N~:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY SONS NAMED ABOVE ON THE TIME MO. AY YEAR 0 0 RELIGIOUS DATE AND AT THE TIME AND PLACE INDICAT 9 0 OTHER, SPECIFY Cou~utchess C,TYfTowJt'{appinger ~~~:~CR~ 368 ~5~1::~A18 1. A. FULL NAME .. F:l B. BIRTH NAME, IF DIFFERENT C. SURNAME AFTER MARRIAGE (OPTIONAL. SEE REVERSI;l28_90_7 551 D. SOCIAL SECURITY NUMBER I 2. RESIDENCE A.NY B. Dutchess (STATE) (COUNTY) c. CHECKONE 0 CITY 0 TOwr(D VILLAGE ~~~CIFY WappinQers Falls D. STREET ADDRESs76 South Remson Ave ZIP 1259U E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? .....0 YES 0 NO 3. A. AG~4 3B. DATE OF BiRTH 1 0 /13 ~ 985 MONTH DAY YEAR 4. EMPLOYMENT A. USUAL OCCUPATION HV AC Installer B. TYPE OF INDUSTRY OR BUSINESSHV AC 5. PLACE OF BIRT~ali, Colombia (CITY, STATE / COUNTRY IF NOT USA) 6. FATHER A. NAME Carlos Alberto Benitez Lopez B. .COUNTRY OF BIRTH Colombia 7. MOTHER A. MAIDEN NAME Maria Del Rosario Conde Serrano B. COUNTRY OF BIRTH Colombia 8. NUMBER OF THIS MARRIAGE 1 9. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT o 0 DOATH 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 ANNULLED, PROVIDE THE FOLLOWING INFORMATION DATE OF DECREE PLACE ISSUED AGAINST WHOM (MONTH, DAY, YEAR) (CITYICOUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE (?..o t>~1 6j-t2 I STATE FILE NUMBER (TH/S SPACE FOR STATE USE ONL Y) I L 0 SUPPLEMENTAL FILE FROM THE BRIDE Viviana Calero ..J 11. A. FULL NAME FIRST MIDDLE CURRENT SURNAME B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT C. SURNAME AFTER MARRIAGE (OPTIONAL - SEE REVERSE) xxx xx XXXX D. SOCIAL ~ITY NUMBER - - II I v orr s 12. RESIDENCE . B. (STATE) 01 (COUNTY) c. CHEC~9tlJh rt 0 CITY 0 TOWN 0 VilLAGE AND Ir{ ~a on SPECI 5 East Dewey D. STREET ADDRESS 0788G ZIP .,. ~614 NO YEAR E. IS ~S~ENCE WITHIN LIMITS OF CITY OR INCORPO~~ VILLAGE~ Q 0 13. A. AGf 3B. DATE OF BIRTH ~ MONTH DAY 14. EMPLOYMENT I d A. USUAL OCCUPATIO~nernp ~~e I d unemp oyt:: B. TYPE OF INDtS~nY ~~PdMf>'a 15. PLACE OF BIRTH ' (CITY. STATE / COUNTRY IF NOT USA) 16. FATHER Adriano Calero Lourido A. NAM~ ~ C I ....1 . oornua B. COUNTRY OF BIRTH 17. MOTHER Liliana Molina Abella A. MAIDEN NAME C I b oom la B. COUNTRY OF BIRTH 1 18. NUMBER OF THIS MARRIAGE 19. PREVIOUS MARRIAGES A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY lflvORCE CIVIL "tjNULMENT D(fTH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE C. DATE LAST MARRIAGE ENDED? (3) 0 ANNULMENT (2) 0 DEATH / / .. ..- YEAR MONTH DAY D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO .. 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION DATE OF DECREE PLACE ISSUED AGAINST WHOM (MONTH, DAY, YEAR) (CITY/COUNTY. STATElCOUNTRY. IF NOT USA) SELF SPOUSE YEAR 28. PLACE WHERE MARRIAGE OCCURRED A. STATE NEW YORK B. COUNTY "J)...} ld~ C. LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) NAME (PRINT) SIGNATURE.