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STATE OF.NEW:YORK
DEPARTMENT OF HEALTH
AFFIDA VIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Daniel
FIRST
o 1~ 0
o 2ND 0
o ~D 0
o c-J 4TH 0
t of my knowledge and belief that the information I provided is true and that I declare that no legal Impediment exists
I.i ~ 22. SIGNATURE OF BRIDE ~ r: ~0 L 9 ~
E CURREN -g5E CU RENT NAME
23. SUBSCRIBED AND SWORN TO BEFORE ME . Depu ty Town Clerk ' DATE May 4, 2000
SIGNATURE OF TOWN OR CITY CLERK ~
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 onl for the rpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
ine Town Clerk
DATE5/4/2000
NY 12590
A
27. TYPE OF CEREMONY
o 0 RELIGIOUS
t;o 9 0 OTHER, SPECIFY
COUNTY
~*'!i'WN
OIS , ~T
NUMB R
REGISTER
NUMBER
Dutchess
Wappinger
1368
53
1. A. FUll NAME
Martinez
CURRENT SURNAME
MIDDlE
<l.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL- SEE REVERSE) 105 62 6380
D. SOCIAL SECURITY NUMBER - -
2. RESIDENCE A. New York B Dutchess
(STATE) (COUNTY)
C. CHECK ONE C CITY 0 TOWN IX VILLAGE
~~gcIFY Wappingers Falls
D. STREET ADDRESS 14 Fulton Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VIllAGE? ~ YES 0 NO
/21 /1976
DAY YEAR
3. A. AGE
23
3B. DATE OF BIRTH
May
MONTH
Ow
O'I~
Lf'\S;
N
......
4. EMPLOYMENT
A. USUAL OCCUPATION Production Operator
B. TYPE OF INDUSTRY OR BUSINESS IBM Corp.
5. PLACE OF BIRTH Brookl vn. New York
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME
B, COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Francisco Martinez
Puerto Rico
Margarita JaYi.e.r..
Dominican Republic
First
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? (31 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) D DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? eYES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEARI CITY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
21. SIGNATURE OF GROOM ~
w
(/)
Z
W
o
::i
~
{ SEAL}
'-v-/
SIGNATURE ~
MAILING ADDRE;J>
PO Box j
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE 1M AY
DATE AND AT THE TIME AND . '" AM / 1.2
PLACE INDICATED, ~ ratlIt cO
~~~~~
SIGNATURE ~ ~ ~
MAILING ADORE /)
If ~U6l2l1'IM"~ n... ~hA~ ~s
STREET CITYITOWN
30. WITNESS TO CER MONY
/Cdt..
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
~
/ ~(,,\ol)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. FUllNAME Kelly J.
FIRST MIDDLE
--.J
Wheeler
CURRENT SURNAME
B. BlR1li NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Martinez
(OPTlONAl . SEE REVERSE) 093 74 8 15
D. SOCIAL SECURITY NUMBER - - 9
12. RESIOENCEA New York B Dutchess
(STATE) . (COUNTY)
C. CHECK ONE 0 CITY ::] TOWN 00 VILLAGE
~gclFY Wappingers Falls
D. STREET ADDRESS 14 Fulton Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILIlAGE? ~ YES ::] NO
13. A. AGE 23 13,8. DATE OF BIRTH Feb. / 9 /1977
MONTH DAY YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION Office Manager
B. TYPE OF INDUSTRY OR BUSINESS OAO TechnolOgies
15. PLACE OF BIRTH New Rochelle , New York olutl.ons
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Joseph Wheeler
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
Regina Yaeger
USA
First
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID lAST MARRIAGE END? 13) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
.31 0 ANNULMENT
/ /
(21 = DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? = YES :] 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
--'
25. B. SOlEMNIZATION PERIOD
ENOS AT MIDNIGHT ON:
TIME
MONTH
DAY
YEAR
MONTH
DAY
YEAR
AM
3: 15 PM
5
5
00
7
3
00
1 iJiJ. CIVIL
28, PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTYiJftcHGSS
TI~!4;~1'd~
DATE 1/!,9tI12 --<'M~
Nil /dS-9o
STATE
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF ;4. VIllAGE OF
SPECIFY ~~ mJ.J.J
NAME (PRINT)
SIGNATURE ~
DClH-8I (111I8)
NAME (PRINT)
SlBNATUAE.