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COUNT-,Qutchess
CITYiTOWN Wappinqer
~~J~~CRT1368
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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Thomas M. Stinson
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
I
4ff1f/,t
;7 ~ 1'3 . C ~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Deborah A. Frampton
MIDDLE CURRENT SURNAME
J
1 A. FULL NAME
11. A FULL NAME
FIRST
FIRST
0-
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Stinson
(OPTIONAL' SEE REVERSEhg 6
D SOCIAL SECURITY NUMBER U 2- 0-4402
12 RESIDENCE ANew York BDutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
~~~cIFEoughkeepsie
D STREET ADDRESB2 Vassar Road
ZIP 12603
o YES'6 NO
14~7
YEAR
BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEOlo80-48-1668
o SOCIAL SECURITY NUMBER U
2 RESIDENCE ANew York B Dutchess
(STATE) .L. (COUNTY)
C CHECK ONE 0 CITYLJ TOWN 0 VILLAGE
~~~CIFY Pouqhkeepsie
D STREET ADDRES~2 Vassar Road ZIP 12603
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES"O NO
Al1 /1958
DAY YEAR
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE'
13. A. AGE4n 13.8. DATE OF BIRTH n1 47
MONTH DAY
3. A AGe43
11
MONTH
3B. DATE OF BIRTH
4 EMPLOYMENT
A. USUAL OCCUPATION Landscaper
B. TYPE OF INDUSTRY OR BUSINESSSelf Employed
PLACE OF BIRTJJeekskill, New York
(CITY, STATE/COUNTRY IF NOT USA)
6 FATHER
A. NAME Thomas Stinson
B COUNTRY OF BIRTHU S A
7. MOTHER
A MAIDEN NAME Catherine I anda
8. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE2
14. EMPLOYMENT
A. USUAL OCCUPATIONDav Care Provider
B TYPE OF INDUSTRY OR BUSINESSSelf Employed
15. PLACE OF BIRT~acksonville..L North Carolina
(CITY, STATE/COUNIHY IF NOT USA)
16. FATHER
A. NAMEEdward Frampton
8. COUNTRY OF BIRTU S A
17. MOTHER
A MAIDEN NAME.Jmm M~c Ph",il
B. COUNTRY OF BIRTU S A
18. NUMBER OF THIS MARRIAGE 2
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9 PREVIOUS MARRIAGES 19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT DEATH DIVORCE CIVIL ANNULMENT
1 0 0 1 0
B HOW DID LAST MARRIAGE END' (3)'0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH 8. HOW DID LAST MARRIAGE END? (3)t:J DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C DATE LAST MARRIAGE ENDED? 07 / 09 /2002 c. DATE LAST MARRIAGE ENDED? 04 /26 /7002
MONil;l DAY YEAR MON~!], DAY YEAR
D ARE ANY FORMER SPOUSE(S) ALIVE? TI YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 'D YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION 20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST07/09/2002 Poughkeepsie, New Ynrk -6 0 1ST04P~l7nn7 Pnllghkp.epsie, New ynft( 0 ofJ
2ND 0 0 2ND 0
3RD 0 0 3RD 0
4TH 0 0 4TH
I, being duly sworn, depose and say',,~e best of my knowle ge and ref that the infor~ation I provided is true
as to my right to enter into the marria~
21 SIGNATURE OF GROOM ~ 2."SlG'NATURE OF BRIDE ~
SE URRE
DEATH
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USE CURRENT NAME
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23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~ D
This license authorizes the marriage in New York St the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within ew 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) Gloria
TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ AT~7111/2002
'-,-I !~~~fa~~~USh Rd W o!alls NYST~~590 liP 2:30 ~~ 07 12 2002 09 09 2002
I CERTIFY THAT I SOLEMNIZEO 27. TYPE OF CEREMONY 28. PLACE WHERE MARRIAGE OCCURRED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
YEAR
o 0 RElIGIOUS
9 0 OTHER, SPECIFY
1 Dt"CIVIL
A. STATE NEW YORK B COUNTY
[) IJrcHE<;
::;/
29. OFFICIANT
NAME (PRINT)
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ;R' TOWN OF 0 VILLAGE OF
SPECIFY u )-tIt -p.p I N rJ- EQ
fY) 0- 61-)
ZIP
WITNESS TO L5dJ~~C'A-h
NAME (PRINT) n /9. J _
SIGNATURE ~ ill J1JllJ}~=::!1.. ~
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