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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Armando
FIRST
1ST
2ND
3RD
4TH
and belief that the information I provided is tru
23. SUBSCRIBED AND SWORN 0 BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK.
This license authorizes the marriage in New York S te 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 urpose of a second or subsequent ceremony.
~ 24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRIN~Elaine H~den, Town Clerk
{ SEAL SIGNATURE_~IH..D l.\ ~Aa.,_ DATE 3/23/00 TIME MONTH DAY YEAR MONTH DAY
MAILINq ADDRI;.S.$ AM
'-.t-I sPO Box jl4, Wa in ers Falls, NY 12590 3 :30 PM 3 24 00 05 22
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY 28. PLACE WHERE MARRIAGE OCCURRED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE 0 0 RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. 9 0 OTHER, SPECIFY
C(l!JNTY
~ITOWN
DISTRICT
NUMBER
REGISTER
NUMBER
Dutchess
Wappinger
1368
26
r
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
1. A. FULL NAME
Patino
CURRENT SURNAME
~ ~/,~1?V
L 0 SUPPLEMENTAL FILE
~
MIDDLE
Cl.
;:::;
BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBER
2. RESIDENCE A._ New York B. Orange
(STATE I (COUNTY)
C CHECK ONE c: CITY ~ TOWN 0 VILLAGE
~~~CIFY Newburgh
D. STREET ADDRESS 1 Chadwick Gardens ZIP 1250
E. IS RESIDENCE WITHiN LIMITS o~15R IN~diM6RATED VILLAGE? 0 YES ~ NO
3. A. AGE 58 3B.DATEOFBIRTH Aug. /22 /1941
MONTH DAY YEAR
11. A. FULL NAME
FROM THE BRIDE
Maria
FIRST
Ospina
CURRENT SURNAME
112-40-4412
4. EMPLOYMENT
A. USUAL OCCUPATION Supervisor /Housekeeping
B. TYPE OF INDUSTRY OR BUSINESS Newburgh Mall
5. PLACE OF BIRTH Medennin. Colomb ia
(CITY. STATE/COUNTRY IF NOT USA)
6. FATHER
l-
s:
c(
A. NAME Juan Patino
B. COUNTRY OF BIRTH Colombia
7. MOTHER
Carmen
MIDDLE
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York
(STATE)
C. CHECK ONE 0 CITY Xl TOWN c:
~~~CIFY Newburgh
D. STREET ADDRESS 3 Chadwick Gardens
APt. J:S4U
E. is RESIDENCE WITHIN LIMITS OF CIl" OR INCORPORATED VILLAGE? 0
13. A. AGE 51 13.B. DATE OF BIRTH Dec. /01
MONTH DAY
Ospina-Patino
071-84-5579
B. Orange
(COUNTY)
VILLAGE
12550
YES 0 NO
/1948
YEAR
Celva Lopez
Colombia
8 NUMBER OF THIS MARRIAGE Second
A. MAIDEN NAME
B. COUNTRY OF BIRTH
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
DEATH
ZIP
14. EMPLOYMENT
A. USUAL OCCUPATION Housekeeper
B. TYPE OF INDUSTRY OR BUSINESS Own Home
15. PLACE OF BIRTH La Maria-Valle. Colombia
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Emanuel Ospina
B. COUNTRYOFBIRTH Colombia
17. MOTHER
Sara Sanchez
Colombia
18. NUMBER OF THIS MARRIAGE Firs t
A. MAIDEN NAME
B. COUNTRY OF BIRTH
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? Nov. / 17 /1999
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? Xi YES C NO
10. 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
11/17/99 Orange Co., NY Xi
.~
--"
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21.
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B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) C ANNULMENT
/ /
(2) = DEATH
YEAR
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? = YES 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
r"
--"
o
C
Deputy
23. 2000
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
YEAR
00
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SIGNATURE
MAILING ADDRESS .3"""'1
~/, ~-e.. ~
STREET
30. WITNESS TO CE
NAME (PRINT)'
SIGNATURE ~
DOH-88 (tillS)
l~IVIL
A. STATE NEW YORK B. COUNTYC~ e.
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF I:lA'6WN OF 0 VILLAGE OF
SPECIFY ~~ 6v"""7 4
~
NAME (PAM)
SIGNATURE~