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COUNTY Dutchess
CITYfTOWN Wappinger
~~~~~c: 1368
~~~I~J~R 162
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Paul Anthony Zucco
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(TH/S SPACE FOR STATE USE ONLY)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Deena Leigh Bartley
MIDDLE CURRENT SURNAME
-1
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
0..
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Zucco
(OPTIONAL. SEE REVERSE) 414-43-9680
D. SOCIAL SECURITY NUMBER
12. RESIDENCEA. New York B. Dutchess
(STATE)..J (COUNTY)
C. CHECK ONE 0 CITY LJ TOWN 0 VILLAGE
~~~CIFY Fishkill
D. STREET ADDRESS ~ U Locust <..;ourt ZIP 1 LOL4
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
13 A. AGE 37 3B. DATE OF BIRTH 02 /16 )t 69
MONTH DAY YEAR
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL' SEE REVERSE) 120-46-0893
D. SOCIAL SECURITY NUMBER
2. RESIDENCEA. New York B. Dutchess
(STATE) oJ (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN 0 VILLAGE
~~~CIFY Fishkill
D. STREET ADDRESS 3 D Locust Court ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0
3. A. AGE 45 3B. DATE OF BIRTH 09 / 28
MONTH DAY
12524
YES ~ NO
/ 1961
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Engineer
B. TYPE OF INDUSTRY OR BUSINEf.3 IBMCorp.
5. PLACEOFBIRTH Kingston, ew York
(CITY, STATE I COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION School Psychologist
Anderson ticnool
B. TYPE OF INDUl('fY OR BUSlltEsr
15. PLACE OF BIRTH mgspo, ennessee
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
16. FATHER
A. NAME Everette Lee Bartley
, UtiA
B. COUNTRY OF BIRTH
17. MOTHER .
Wilma Geneva Dean
A. MAIDEN NAME
UtiA
B. COUNTRY OF BIRTH I
18. NUMBER OF THIS MARRIAGE
A. NAME Vincent S. Zucco
B. COUNTRY OF BIRTH USA
7. MOTHER
Jean M. Moles
A. MAIDEN NAME
USA
B. COUNTRY OF BIRTH
L
8. NUMBER OF THIS MARRIAGE
DEAQH
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV8RCE CIVIL AN~LMENT
D~H
a:
w
III
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a:
Iii
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D1VOqCE CIVIL ANN~LMENT
~
B. HOW DID LAST MARRIAGE END? (3)OOIVORCU3'T3)O i\~~i:MENT
C. DATE LAST MARRIAGE ENDED? / /
MONTH .,I DAY
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
("1Ol':I.Tti04 W'y'1'@Rl.p(CITY/CQUIlTY,STATEl,COUNlIlY, IF N~US~ S~ SPOUSE
1ST U6f"1 0,. ~~o ougnKeepsle, I\lew or 0 0 1ST
2ND 0 0 2ND
3RD 0 0 3RD
~ 0 0 ~
I duly swear/affirm, depose and say, th owledge and belief that the information I provided is true
as to my right to enter into the mar
21. SIGNATURE OF GROOM~
06
"1.~9tf~ -"""-B:"rfOVVDl[JIJI.Si'MARRfAGE"END?----l3rEl"D1VORCE"'" "(3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / /
YEAR MONTH DAY - YEAR
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
o
o
o
o
o
nd that I declare that no legal impedi
d. ~
USE CURRENT NAME
USE
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATU~E 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 CI~8t\~ C. Masterson 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
SEAL SIGNATURE ~ Q 0-('. -V ~ DATE 10/04/200 TIME MONTH YEAR
'-v-' ."'!ll_Iebugli'l'ld, 'W a~p'inger Falls, NY 125~0 03 :51AM 10
STREET CITYITOWN STATE ZIP PM
~~~R~:RT~~J IO~O~~~N~ZEE~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED A80VE ON THE TIME MO. DAY YEAR 0 ~ RELIGIOUS
DATE AND AT THE TIME AND
PLACE INDICATED. \ : \) 200'- 90 OTHER, SPECIFY
( ; ...s".'" ....<-.
~~~n~~~ SQ........ ~D ""-qs",,.l 'T~..)(..<.~~ TITLE ~<.".C'C.f\.l. ~..-tv:::~..~~
SIGNATURE ~ ~..... t.}'~-::-j ~ ..:: J~ DATE \1.\ 0...... '2.t>t:>1.
MAILING ADDRESS ~
'3S \.\1.,,~ ':r\.) ~b t.." nl. \~c-'n.n~~cN N'l.
STREET CITY/TOWN STATE
30. WITNESS TO CER MONY ~ '
NAME (PRINT) I ~ /;,/<J:..~S::5:./C)
DATE
by New York Domestic
YEAR
28. PLACE WHERE MARRIAGE OCCURRED
10 CIVIL
A. STATE NEW YORK B. COUNTY U\5-\-<'('
n'441o
ZIP
31. WITNESS TO CEREMONY
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY \J -.~r<';""j
SIGNATURE~
NAME (PRINT)
SIGNATURE~