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DEPARTMENT OF HEALTH
AFRDAVIT,UCENSEand
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Peter Michael Pinto
MIDDLE CURREiIlT SURNAME
COUNTY Dutchess
CITYfroWN Wappinger
~~~:~~1368 .
~5~1~~~R 74
1 . A. FULL NAME
FIRST
0-
N
B. BIRTH NAME, IF D1FFEREiIlT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSEh63 70 6158
D. SOCIAL SECURITY NUMBER U - -
2 RESIDENCE A. NY B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY..o TOWN 0 VILLAGE
~~~CIFY Wappinqer
o STREET ADDRESS 29 Robert Lane ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES~ NO
06 /02 /1979
MOillTH DAY YEAR
3. A. AGE 30
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION HV AC Mechanic
B. TYPE OF INDUSTRY OR BUSINESS HV AC
5. PLACE OF BIRTH Mt. Kisco, NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Jose C Pinto
B. COUNTRY OF BIRTH Portugal
7. MOTHER
A. MAIDEN NAME Peggy A Rossmann
B. COUNTRY OF BIRTH USA
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 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) (CITY/COUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
(THIS SPACE FOR STATE USE ONLY)
Lo
.J
SUPPLEMENTAL FILE
FROM THE BRIDE
Hope Lindsay Donohue
MIDDLE CURRENT SURNAME
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFEREiIlT
C. SURNAME AFTER MARRIAGE Pinto
(OPTIONAL - SEE REVERSE079_72_3595
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A.NY BDutchess
(STATE) oJ.... (COUNTY)
C. CHECK ONE 0 CITY "LJ TOWN 0 VILLAGE
~~~CIFY W aPEi nger
D. STREET ADORES? Alpert Dnve
ZIP 12b90
o YES.....O NO
)979
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE29 3B. DATE OF BIRTH 11 )r8
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
B. TYPE OF INDUSTRY OR BUSINESS WCSD
15. PLACE OF BIRTHPoughkeepsie, NY
(CITY, STATE / COUiIlTRY IF NOT USA)
16. FATHER
A. NAMEEdward P. Donohue
'B. COUNTRY OF BIRT~ S A
17. MOTHER
A. MAIDEN NAME Nancy Ruth O'Brien
B. COUNTRY OF BIRT~ S A
1B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DID, TH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. - YEAR
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
1ST
2ND
3RD
o
o
o
o
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STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
29. OFFICIANT
NAME (PRINT)
SIGNATURE ~
MAILING ADORE S
v.~
STREET CITYrrow
30. WITNESS TO CEREMONY 1?
NAME (PRINT) N/v-',~(r.~ <: ~f~
SIGNATURE~ ~ ~
DOH-9B (03/2006)
DATE
07/14/2009
by New York Domestic
MONTH
YEAR
09
12 2009
2B. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY \)u.::h: k.o..t1
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF [YfOWN OF 0 VILLAGE OF
SPECIFY ~-\- 4-=\. s ~ l ~ \ \
,
NAME (PRINT)
SIGNATURE~