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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Robert Francisco Monteiro JR.
FIRST MIDDLE CURRENT SURNAME
FIRST
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~~ 1368 .
~E~~~~R 180
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Catherine Irene Greevv
MIDDLE CURRENT SURNAME
11. A. FULL NAME
0-
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 072 58 1389
D. SOCIAL SECURITY NUMBER --
2. RESIDENCE A. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFY Wappingers Falls
D. STREET ADDRESS 6 West Academy Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? c1 YES 0 NO
3. A. AGE :i4 3B. DATE OF BIRTH 04 / /0 / 1972
MONTH DAY YEAR
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Monteiro
(OPTIONAL - SEE REVERSE) 082-54-5538
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN ~ VILLAGE
~~~CIFY Wappinqers Falls
D. STREET ADDRESS 6 West Academy Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 1'1 YES 0 NO
11 /02 /1971
MONTH DAY YEAR
13. A. AGE 35
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION H V A C Technician
B. TYPE OF INDUSTRY OR BUSINESS Comfortmaster
5. PLACEOFBIRTH Long Beach. California
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Rohert Fr;:mcisco Monteiro, Sr
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Eileen Byrne
B. COUNTRY OF BIRTH USA
B. NUMBER OF THIS MARRIAGE 2
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
14. EMPLOYMENT
A. USUAL OCCUPATION Domestic Engineer
B. TYPE OF INDUSTRY OR BUSINESS
15. PLACE OF BIRTH Bronx, New York
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Edward Greevy
'B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Mary Ellen Moore
B. COUNTRY OF BIRTH USA
1B. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
DEATH
o
w
en
z
w
o
::::;
B. HOW DID LAST MARRIAGE END? (3) ciDIVORCE (3) 0 ANNULMENT (2) 0 DEATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 01/ 19 / 2006 C. DATE LAST MARRIAGE ENDED?' / (
MONTH DAY YEAR MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
to
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY/COUNTY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 01/19/2006 Poughkeepsie. New York 0 ci 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I duly swear/affirm, dep.ose and hat to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into th estate. i' ' . .' ~
21. SIGNATURE OF GROO 22. SIG TURE OF BRIDE ~ (Jl,\\;.ho 1\t.Jl ~ ~~
23. SUBSCRIBED AND SWORN T fA ~FORE ~~E CU E NAM USE RRE AME
SIGNATURE OF TOWN OR CITY CLE K~ DATE 12 4/2006
This license authorizes the marriage in New 'York State of bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New York te. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked. this license is to be used nly for the purpose of a second or subsequent ceremony.
24. TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT) J n C,
r-^-.
{ SEAL }
'-.t-I
TIME
MONTH
YEAR
MONTH
YEAR
DATE 12/04/200
d, Wappinqer Falls, NY 12590
CITYrrOWN STATE ZIP
26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
TIME MO. DAY YEAR 0 0 RELIGIOUS
.!:-... 9 0 OTHER, SPECIFY
SIGNATURE ~
MAILING ADDflEl;'
20 Mioo.
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
AM
02:58PM
12
05
2006
02
02 2007
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUN~' d-t-iu,~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~N OF 0 VILLAGE OF
SPECIFY '\..).. )(i ffl ~ e r-
1~ivlL
NAME (PRINT)
SIGNATURE~
DOH-9B (03/2006)
NAME (PRINT)
SIGNATURE~