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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
KFlvin PirFl~ SiIV::l
MIDDLE CURRENT SURNAME
o 0 1ST
o 0 2ND
o 0 3RD
o 0 4TH
Y knowledge and belief that the information I provided is tr
USE CU
23, SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
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
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) John C. Masterson
TIME MONTH YEAR
SEAL SIGNATURE ~ DATE
"-Y-I MAI2~~~~~~ 12:34~~ 09
COUNTY Dutchess
CITYfTOWN Wappinger
~~~:~c~ 1368 .
~5~1~~~R 1 04
, . A. FULL NAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 012 68 1163
D. SOCIAL SECURITY NUMBER _ _ _ - _ _ - _ - --
2. RESIDENCEA. RI B. Rri~t('}1
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Bristol
D. STREET ADDRESS 6 Howe Street: Apt 2 ZIP 02809
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
3. A. AGE ?4 3B. DATE OF BIRTH 10 /?~ / 19R4
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION C::lrpenter
B. TYPE OF INDUSTRY OR BUSINESS Construction
5. PLACE OF BIRTH Fall River MA
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Fern::lndo Melo Silva
B. COUNTRY OF BIRTH St. Michaels. Azores
7. MOTHER
A. MAIDEN NAME Ana Paula Pires
B. COUNTRY OF BIRTH St. Michaels. Azores
B. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH OA Y 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) (CITY/COUNTY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
DATE
.
t.-'
I
STATE FILE NUMBER
(TH/S SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Joan Butler Devine
MIDDLE CURRENT SURNAME
.-J
11. A FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C. SURNAME AFTER MARRIAGE Silva-Devine
(OPTIONAL - SEE REVERSE) 130 68-4554
D. SOCIAL SECURITY NUMBER -
12. RESIDENCE A. RI B Bristol
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Bristol
D. STREET ADDRESS 6 Howe Street; Apt 2
ZIP 02809
DYES tJ NO
/1'974
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE 35 3B. DATE OF BIRTH 07 /02
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Self Employed
B. TYPE OF INDUSTRY OR BUSINESS Pet Boutique
15. PLACE OF BIRTH Chicaoo. IL
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME John Frederick Devine
. B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Elizabeth McCormick Butler
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. - YEAR
B. HOW DID LAST MARRIAGE END? (3) o DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH OAY
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
22. SIGNATURE OF BRIDE ~
DATE
by New York Domestic
MONTH
YEAR
09
2009
11
07 2009
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEWYORK B.COUNTY~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~WN OF 0 VILLAGE OF
SPECIFY W A-t20;,.,q..n -
f , {
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~