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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael P Davino
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYfTOWN Wappinger
~~~=kc: 1368
~G~I:J~R 18
1 . A. FULL NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 134 72 1478
D. SOCIAL SECURITY NUMBER --
2. RESIDENCEA. New York B. Oranae
(STATE) (couNTYj"
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~CIFY Newburgh
D. STREET ADDRESS 504 Cortland Drive ZIP 12550
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES tJ NO
3. A. AGE /9 3B. DATE OF BiRTH 05 / 15 / 1977
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Real Estate Consultant
B. TYPE OF INDUSTRY OR BUSINESS Real Estate
5. PLACE OF BIRTH Bronx. New York
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Paul Anthony Davino
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Nancy Cantarini
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?
(2) 0 DEATH
(3) 0 ANNULMENT
/ /
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, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
l1e1
a~f.1)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
En~}I~~J yn n RUP~~ENT SURNAME
~
11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Davi n 0
(OPTIONAL - SEE REVERSE) 070 74-1438
D. SOCIAL SECURITY NUMBER -
12. RESIDENCE A. New York B. Oranae
(STATE) (COUN1'Y)
C. CHECK ONE 0 CITY l!l TOWN 0 VILLAGE
~~~CIFY Newburqh
D. STREET ADDRESS 504 Cortland Drive ZIP 12550
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
07 /06 A977
MONTH DAY YEAR
13. A. AGE 29
14. EMPLOYMENT
A. USUAL OCCUPATION Case Manaqer
B. TYPE OF INDUSTRY OR BUSINESS Social Services
15. PLACE OF BIRTH Albany, New York
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Peter Lynn Rupert
'B. COUNTRY OF BIRTH USA
3B. DATE OF BIRTH
17. MOTHER
A. MAIDEN NAME Linda Jean Bannerman
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
B. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
.'- YEAR
C. DATE LAST MARRIAGE ENDED?
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, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
o 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
22. SIGNATURE OF BRIDE~ &~ ~ I L? {A__-/-
=---=ttSE CURRENT ~E
DATE 03/14/2007
US
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New Y State of t e 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 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 MONTH
SEAL SIGNATURE~' DATE 03/14/2007
MAI~~G f-.QIPdREFi AM
'-v-' LU M 01 appinQer Falls, NY 12590 06:28PM 03 15 2007 05 13 2007
STREET ClTYrrowN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 0 RELIGIOUS
DATE AND AT THE TIME AND AM
PLACE INDICATED. PM 9 0 OTHER, SPECIFY
W
en
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(.)
:::::i
29. OFFICIANT
NAME (PRINT)
TITLE
SIGNATURE ~
MAILING ADDRESS
DATE
STREET
30. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~
DOH-sa (0312006)
CITY fTOWN
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) ~.
o CITY OF 0 TOWN OF 0 VILLAGE OF
SPECIFY
STATE
ZIP
31. WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE~