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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Junior Luna
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITY/TOWN Wappinger
DISTRICT1368 '
NUMBER
REGISTER48
NUMBER
1 ' A, FULL NAME
FIRST
0-
N
B, BIRTH NAME, IF DIFFERENT
C, SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE075_56_8612
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITYIIIfJ TOWN 0 VILLAGE
AND P hk .
SPECIFY ou~ eepsle
D. STREET ADDRESS Pewter Ct
ZIP 12603
./..
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 NO
11 /26 /1974
DAY YEAR
3. A. AGE35
3B. DATE OF BIRTH
MONTH
4. EMPLOYMENT
A USUAL OCCUPATION Overnight Stock
B: TYPE OF INDUSTRY OR BUSINESS Retail
5. PLACE OF BIRTH Bronx, NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Angel Morel
B. COUNTRY OF BIRTH Dominican Republic
7. MOTHER
A. MAIDEN NAME Mercedes Luna
B. COUNTRY OF BIRTH Dominican Republic
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
D~TH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Crystal Liana Barrington
MIDDLE CURRENT SURNAME
--1
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME)S DIFF~RENT
C. SURNAME AFTER MARRIAGE arrington-Luna
(OPTIONAL - SEE REVERS~85_7 4-0805
D. SOCIAL SECURITY NUMBER
12. RESIDENCE l-JY BDutchess
(STATE) .I,. (COUNTY)
C. CHECK qt!,E hO CITY 0 TOWN 0 VILLAGE
~~~clFY':.oug IKeepsle
D. STREET ADDREsP t-'ewter Gt ZIpI2603
~
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE~ 0 Y!lS"19gNO
13. A. AG~O 38. DATE OF BIRTH 07 ~ ~
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATIONCollections
l::SanKlng
B. TYPE OF IND~TRY Ofl ,BUSINESS
15. PLACE OF BIRn.r=.ougnKeepsle, NY
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAM~ohn Lee Barrington
'B. COUNTRY OF BIRT~ ~ A
17. MOTHER
A. MAIDEN NAMEEve1yn Negron
B. COUNTRY OF B;;;rue~o Klco
lB. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DffORCE CIVIL A~ULMENT
D(j'TH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. ~ YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
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, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
o
o
o
11:'
III
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1ST
2ND
3RD
4TH
I duly swear/affirm, dep'ose and
as to my right to enter into the I'l'I
21. SIGNATURE OF GROO
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
Y knowledge and belief that the information I provided is
TITLE \\~~ \~'\ \ ~~ 1\g 1\\
~\J DATE c)\9 \\G...\2U\\l
'\'-l'\ \ '\ \2'\ \g \
NAME (PRINT)
SIGNATURE~
DOH-98 (0312006)
MONTH
YEAR
SE CUR NT NA
23. SUBSCRIBED AND SWOR TO FFIRMED BEFORE ME
SIGNATURE OF TOWN OR CLERK ~
This license authorizes the marriage in New York Sta of the bride and groom named above by an person authorized
W Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
tn 0 If checked, this license is to be used only for the purpose of a second or subsequent ceremony.
Z ~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
W } NAME (PRINT) John C. Masterson
(.) { ~. 05/07/2010 TIME MONTH DAY YEAR
:::::i SEAL SIGNATURE ~ I..-: DATE
~ MA~5GIOO'Erdf~ ush Rd, Wappingers Falls, NY 12590 02:04 AM 05 08 2010
STREET CITYITOWN STATE ZIP PM
I CERTIFY THAT I SOLEMNIZED 26 SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER- .
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS 1 IVIL
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
07
06 2010
28. PLACE WHERE MARRIAGE OCCUR{D
A. STATE NEW YORK B. COUNTY ~~
C. LOCATION OF CEREMONY
(CHECK ONE AND JPECIFY)
o CITY OF MOWN OF 0 VILLAGE OF
SPECIFY\j>.{\ \\ \ ~(). ~ (
~ ~
STATE
31. WITNESS TO
NAME (PRINT)
SIGNATURE~