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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Ronald Michael
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE)
o SOCIAL SECURITY NUMBECI
2 RESIDENCEA. New York B. Dutchess
(STATE, ~ ICOUNTY)
C CHECK ONE c: CITY ~ TOWN = VILLAGE
~~~CIFY Poughkeepsie
o STREET ADDRESS 65 Spring Road
COUNTY
cmurOWN
..DISTRICT
NUMBER .
REGISTER
NUMBER
Dutchess
Wappinger
1368
133
1. A. FULL NAME
B BIRTH NAME. IF DIFFERENT
Zambri
FIRST
MIDDLE
CURRENT SURNAME
082-48-2170
ZIP
12601
E. IS RESIDENCE WITHiN LMITS OF CITY OR INCORPORATED VILLAGE? ' ,
3. A. AGE 46 38. DATE OF BIRTH Feb. / 13
MONTH DAY
YES ro NO
/1954
YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Produce Manager
B. TYPE OF INDUSTRY OR BUSINESS A&P Supermarkets
5. PLACE OF BIRTH Bronx, New York
(CITY. STATE COUNTRY IF NOT USA)
6. FATHER
A. NAME
B. COUNTRY OF BIRTH
7. MOTHER
A. MAIDEN NAME
B. COUNTRY OF BIRTH
B. NUMBER OF THIS MARRIAGE
John Zambri
USA
Marion Simonelli
USA
Second
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
DEATH
B. HOW DID LAST MARRIAGE END? ,31 X DIVORCE (31 C ANNULMENT (2) I....: DEAT"
C. DATE LAST MARRIAGE "NDED? Aug. / 5 / 1998
\IONTH DAY YEAR
D. ARE ANY FORMER SPCUSE(S) ALIVE? X YES C NO
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIDE THE FOLLOWING INFORMATICN
DATE OF DECREE PLACE ISSUED AGAINST WHCM
(MONTH. DAY. YEARI CITY. STATE COUNTRY. IF NOT USA) SELF SPOUSE
8/5/98 Rockland Co.. New York ~
4Th
thenrormatlon I provided is true and that I declare that no legal impeaiment eXists
22~GNATURE OF BRIDE ~ ~OV"l.c.-. o.../Yl./1l.1 'Iil ~a.MJ
USE CUPRENT NAME
23 Deput Town Clerk DATE Aug. 10. 2000
This license authorizes the marriage in New York at of the 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.
If checked. this license is to be used only for the purpose of a second or subsequent ceremony.
CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
Elaine Town Clerk
DATE 8/10/00
NY 12590
STATE
27. TYPE OF CEREMCNY
'~L
21.
w
en
z
w
o
:J
~
{ SEAL}
'-v-I
NAME ,PRINT)
SIGNATURE
MAILING ADDR
PO Box
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON Tf-'
DATE AND AT THE TI , 0
PLACE INDICATED.
NAME (PRINT)
SIGNATURE ~
DOH-9B (1/98)
OTHER. SPECIFY
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
~/oIJj/~D
L [J SUPPLEMENTAL FILE
FROM THE BRIDE
Debra Ann
~
Mohan
,1. A. FULL NAME
FIRST
CURRENT SURNAME
Hoferichter
Zambri
089-52-6089
Dutchess
MIDDLE
B. BIRTH NAME ,MAIDEN NAME). IF DIFFERENT
C. SURNAME~FTER MARRIAGE
,OPTIONAL. SEE REVERSE)
SDCIAL SECURITY NUMBER
New York
,STATE) ,COUNTYI
C CITY Xi TOWN " VILLAGE
Poughkeepsie
65 Spring Road
12. RESiDENCE A.
B
C. :HECK ONE
~ND
SPECIFY
ZIP
12601
D STREET ADDRESS
..S RESiDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE' r
13. A. AGE 43 13.8. DATE OF BIRTH J an. /23
YES X: NO
/1957
YEAR
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Seafood Manager
B. TYPE OF INDUSTRY OR BUSINESS A&P Supermarkets
15. PLACE OF BIRTH Mt. Kisco, New York
(CITY. STATEiCOUNTRY IF NOT USAI
16. FATHER
A. NAME
B. COUNTRY OF BIRTH
, 7. MOTHER
A. MAIDEN NAME
3. COUNTRY OF BIRTH
Paul Hoferichter
USA
Marilyn
USA
Third
Timmins
lB. '<UMBER OF THIS MARRIAGE
19. P'1EVIOUS MARRIAGES
A. '<UMBE9 CF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
Two
DEATH
3. -iOW DID LAST MARRIAGE END? (3) Xi DIVORCE 31 = ANNULMENT ,21 ~ DEATH
v JATE-ASTMARRIAGEENDED? Feb. /18 /1998
MONT~ JAY YEAR
~. ARE ANY "ORMER SPOUSE(S) ALIVE? ~ YES = NO
20. F ~'1EVICUSLY DIVORCED OR ANNULED. PROVIDE 7HE FOLLOWING INFORMATION
JA TE OF DECREE PLACE ISSUED AGAINST WHCM
MCNTH. DAY. YEARI (CITY. STATE/COUNTRY. IF NOT USAI SELF SPOUSE
4/84 Westchester Co.,NY
2ND 2/18/98 Westchester Co. ,NY
3RD
lSi
X:
X:
25 B SOLEMNIZATION PERIGO
ENOS T MIDNIGHT ON
TIME
DAY
DAY
YEAR
YEAR
MONTH
MONTH
:'p
AM
2 : 15 PM
11
09
00
00
10
8
2B. PLACE WHERE MARRIAGE OCCURRED
A.
C.