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COUNTY Dutchess
CITYfTOWN Wappinqer
~~~~~: 1368 .
~~~~~~R 1 3
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Brian McKinle~ Downe~
MIDDLE CURRENT S NAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Maria Elisa Monteiro
MIDDLE CURRENT SURNAME
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
ll.
N
DYESc"'l"NO
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Downey
(OPTIONAL - SEE REVERSE)
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York
(STATE)
C. CHECK ONE D CITY CY' TOWN D
~~~CIFY Wappinqer
D STREET ADDRESS 107 A All Angels Hill Road ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? DYES r"f NO
12 /03 /1973
MONTH DAY YEAR
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 060-70-1498
D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE D CITY ~ TOWN D VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 107 A All Anqels Hill Road ZIP 12590
B. Dutchess
(COUNTY)
VILLAGE
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
3. A. AGE ~4 38. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Carpenter
B. TYPE OF INDUSTRY OR BUSINESS Sunrise Carpentry
5. PLACE OF BIRTH Carmel. New York
(CITY, STATE / COUNTRY IF NOT USA)
13. A. AGE 33
3B. DATE OF BIRTH
14. EMPLOYMENIT
A. USUAL OCCUPATION Unemployed
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Alpendurada e Matos, Portuqal
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHEA
A. NAME Jose Monteiro
'B. COUNTRY OF BIRTH Portuqal
17. MOTHER
A. MAIDEN NAME Constanca Vieira Da Silva
B. COUNlTRY OF BIRTH Portuqal
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENIT
o 0
DEATH
o
6. FATHER
to-
5>
c(
c
u:::
I.L.
c(
A. NAME Rich8rd William Downey
B. COUNlTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Hollis Alexandra Abele
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENIT
1 0
B. HOW DID LAST MARRIAGE END? (3) c:1'1>IVORCE (3) D ANNULMENT
c. DATE LAST MARRIAGE ENDED? 0 V 23 /
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? OI(ES 0 NO
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? DYES D NO
DEATH
o
(31 D DIVORCE
(31 D ANNULMENT (2) D DEATH
/ /
- YEAR
(2) D DEATH
2007
YEAR
B. HOW DID LAST MARRIAGE END?
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONlTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
01/23/2007 Poughkeepsie. New York if
~
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
w
UJ
Z
W
(.)
::i
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEF
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York State of t
Relations Law ~11 to perform marriage ceremonies within New York te. THIS LICENSE VALID IN NEW YORK STATE ONLY.
D 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) J C. Masterson
/0 f () _ TIME MONlTH YEAR
SEAL SIGNATURE ~ ~. ~ DATE 02/28/200
MAILING .AoP9R\=S$ AM
'-v-' 20 Miadl ush Rd. WappinQer Falls, NY 12590 03:33>M 03
STREET CITY/TOWN STATE ZIP
~~~~~RT~~J 'o~O~~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 D RELIGIOUS 1 ~IVIL
DATE AND AT THE TIME AND rr-
PLACE INDICATED -J:'; P 9 D OTHER, SPECIFY
04
29 2007
by New York Domestic
MONlTH
YEAR
01
2007
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COU~~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
(' D CITY OF ~OWN OF D VILLAGE OF
SPECIFY {1 lc~ ,/)0,' II ~ r
- 71 ' I
ZI
31. WITNESS TO CEREMONY
NAME (PRINT) Su. -SO'...()Q.
SIGNATURE~