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STATE OF NEW YORK
OEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Francisco Javier Del Castillo
FIRST MIDDLE CURRENT SURNAME
1ST
2ND
3RD
4TH
ge and belief that the information I provided is true
23. SUBSCRIBED AND SWORN TO
SIGNATURE OF TOWN OR CITY
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 only for the purpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)~aine H. ~ S~owde~. Town Clerk TIME MONTH DAY YEAR
SEAL SIGNATURE ~~~ flU ~ ~IIA. DATE 8/31/00
MAILING ADDRESS 0: 30 AM
~ PO Box 324. Wappingers Falls. NY 12590 PM 9 1 00
STREET IlY /TOWN ST ATE ZIP
~~~R~~R;~~~ 10~~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR O~GIOUS 1 0 CIVIL
DATE AND AT THE TIME AND AM
PLACE INDICA~ PM 9 0 OTHER. SPECIFY
29. OFFICIANT .J. "" r
NAME (PRINT) V-..l.
Dutchess
Wappi.nger
l1fiR
150
1. A. FULL NAME
B 61RTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRiAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A New York
(STATE)
C. CHECK ONE 0 CITY r! TOWN 0
~~~CIFY Fishkill
D STREETADDRESS 333 Town View Drive ZIP 12590
E. is RESIDENCE WITHiN LIMITS OF d'f~g,gN~l,l~~f,-~D V~ 0 YES ~ NO
3. A. AGE 28 3B.DATEOFBIRTH Nov. /12 /1971
MONTH DAY YEAR
101-70-9201
B. Dutchess
(COUNTY)
VILLAGE
4. EMPLOYMENT
A. USUAL OCCUPATION Sales Manager
B. TYPE OF INDUSTRY OR BUSINESS Airborne Express
5. PLACE OF BIRTH Elmhu r s t. New Y or k
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Rodr:lgo Del Castillo
B. COUNTRY OF BIRTH Ecuador
7. MOTHER
Maria Pinto
Ecuador
B. NUMBER OF THIS MARRIAGE First
A. MAIDEN NAME
B. COUNTRY OF BIRTH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
I STATE FILE NUMBER I
(THIS SPACE FOR STATE USE ONL Y)
~ ,D/I'1/07)
Lo SUPPLEMENTAL FILE ~
11. A. FULL NAME
FROM THE BRIOE
Leslie Jean
FIRST MIDDLE
Paufler
CURRENT SURNAME
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURiTY NUMBER
12 RESIDENCEA. New York
(STATE)
C. CHECK ONE 0 CITY i>> TOWN [J
~~~CIFY Fishkill
D. STREETADDRESS 333 Town View Drive ZIP 12590
wapp~ngers rails
E. IS RESIDENCE WITHIN liMITS OF CITY Oft INCO~RATED VilLAGE? [J YES ~ NO
13. A. AGE 30 13.B. DATE OF BIRTH June /17 /1970
MONTH DAY YEAR
Del Castillo
129-62-2093
Dutchess
(COUNTY)
VILLAGE
B.
14. EMPLOYMENT
A. USUAL OCCUPATION Sales Manager
B. TYPE OF INDUSTRY OR BUSINESS Airborne Express
15. PLACE OF BIRTH Rochester. New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Gregory Paufler
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Carol Bothwell
USA
First
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 WHCM
(MONTH, DAY. YEAR) (CITY, STATE COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
I, being duly sworn. depose and say, t
as to my right to enter into the marria
21. SIGNATURE OF GROOM ~
-,
-'
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
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B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE 131 == ANNULMENT 12\ C DEATH
C. DATE LAST MARRIAGE ENDED? / /
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? eYES C NO
20. 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
u
Domestic
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
MONTH
DAY
YEAR
10
30
00
2B. PLAOE WHERE MARRIAGJf'J~
A. STATE NEW YORK I(/~~ :;i-""
C. LOCATION OF CEREMONY
(CHECK ONE ANJ-SPECIFY)
o CITY OF t{ TOWN OF 0 VILLAGE OF
SPECIFYr~te 7
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NAME (PRINT)
SIGNATURE ~