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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Frank P. Zammiello
FIRST MIDDLE CURRENT SURNAME
B BIRTH NAME. IF DIFFERENT B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE C. SURNAME AFTER MARRIAGE "Fr::lnt7.en-7.::lmmi ell 0
(OPTIONAL. SEE REVERSE) 110-40-6429 (OPTIONAL. SEE REVERSE) 117-50-9589
o SOCIAL SECURITY NUMBER _ _ _ _ _ _ _ D. SOCIAL SECURITY NUMBER
2 RESIDENCE A. New York B. Dutche!'l!'l 12. RESIDENCEA. New York
(STATE I (COUNTY) (STATE)
C CHECK ONE 0 CITY 2S TOWN 0 VILLAGE C. CHECK ONE 0 CITY ~ TOWN 0
~D ~O
SPECIFY l'ol1ehkppp~; p SPECIFY Poughkeepsie
o STREET ADDRESS 103 Sutton Park Road ZIP 12603 0 STREET ADDRESS 103 Sutton Park Road ZIP12603
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? ~ YES 0 NO
3 A AGE 49 3B.DATEOFBIRTH Jan. /22 / 1951 13.A. AGE 43 13.B.DATEOFBIRTH July /20 /1956
MONTH DAY YEAR MONTH DAY YEAR
23, SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE 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 911 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 ~J(,LERK 25, A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) '7~laine H.. Snowdel!.z Town Clerk
{SEAL SIGNATURE~(:tUiL(I\-~~L~,V\.r4CI-- DATE4/14/00 TIME MONTH DAY YEAR
MAILING ADORESi' AM 04 15 00
~ PO Box 3z4, Wappingers Falls, NY 12590 2:45 PM
STREET CITYfTOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY ~'
THE ~IARRIAGE OF THE PE .
SONS NAMED ABOVE 0 RELIGIOUS 1 L~ CIVIL
DATE AND AT THE T
PLACE INDICATED 9 0 OTHER, SPECIFY
COUNTY
~~TOWN
DISTRICT
NUMBER
REGISTER
NUMBER
Dutchess
Wappinger
1368
40
, A FULL NAME
Q.
N
4. EMPLOYMENT
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A USUAL OCCUPATION Contractor
B, TYPE OF INDUSTRY OR BUSINESS Self em,ployed
5. PLACEOFBIRTH Pomrhkeeosie New York
(CITY. STATE/EfiUNTRY IF"NOT USA)
6. FATHER
A NAME Raymond J. Zammiello
B COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Doris Becker
B COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE Second
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
DEATH
B. HOW DID LAST MARRIAGE END? (3) ~ DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? Oct. /01 / 1999
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? XJ YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
10/1/99 nl1t"('hpQ~ r.mmt"y NY ~
o
o
1ST
2ND
3RD
4TH
I, being duly sworn, depose a~d y, that the
as to my right to enter into the age st t .
21, SIGNATURE OF GROOM ~
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STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
/ Eli/IOU
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Colleen P. Frantzen
FIRST MIDDLE CURRENT SURNAME
~
11. A. FULL NAME
Shaw
B Dutchess
(COUNTY)
VILLAGE
14. EMPLOYMENT
A. USUAL OCCUPATION Nursing
B. TYPE OF INDUSTRY OR BUSINESS Lu thern Care Center
15. PLACE OF BIRTH Port Chester New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME
William E. Shaw
USA
B. COUNTRY OF BIRTH
17. MOTHER
A. MAIDEN NAME Patrician Mellon
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE Second
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
DEATH
B. HOW DID LAST MARRIAGE END? (3) 2S DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? July / 22 / 1993
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 2tl YES 0 NO
20. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 7/22/91 Dutchess County NY i1!i 0
2ND 0 0
3RD 0 0
4TH 0 0
iet that the information I provided is true ~d that I declare th no legal impediment exists
22. SIGNATURE OF BRIDE ~ '?' ~...-?t'~
USE CURRENT NAME
.J-..-- De ut Town Clerk
DATE
4/14/00
by New York Domestic
MONTH
YEAR
06
00
13
A STATE NEW YORK B. COU
28 PLACE WHERE MARRIAGE OCCURRED
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF VILLAGE Ob _ 1'-
SPECIFY W"'P/~tU. ~