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N
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Donald Vincent Bennett
MIDDLE CURRENT SURNAME
19. ~~~~I.9~?R~~~/('E<vr8us MARRIAGES WHICH ENDED BY
DIV3RCE CIVIL A,ULMENT D~TH
B. HOW DID LAST MARRIAGE END? (3) E1DIVORCE (3) 0 ANNULMENT do~ DEATH
C. DATE LAST MARRIAGE ENDED? 01 / 03 / 2
D. ARE ANY FORMER SPOUSE(S) ALIV~YES DD~~ ,,- YEAR
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DA;; YEAel (CITYICOUNTY, STATElCOUNTRY, IF ,\Or USA) SELF SPOUSE
1ST 04/18/197 ( Poughkeepsie, New york 0 r1.
2ND 01/14/198b fJOugnKeepSle, New YOrK 8
3RD 01/03/200b Gosnen, New YorK ~1I 0
~ 0 0
t the information I provided is true and that I d~,th~ no legal impediment exists
22. SIGNATURE OF BRIDE~~.LI)":' # (J
USE CURRENT NAM~
fl.J,;i.,_ ~ DATE OS/23/2007
3RD
4TH:
I duly swear/affirm, aep,ose and say I that to the best of my kno
as to my right to enter Into the mamage state. c/
21. SIGNATURE OF GROOM ~ ~
USE CUR
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK"
This license authorizes the marriage in New York te of 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.
o If checked, this license is to be used only for the urpose of a second or subsequent ceremony.
r-"-.. 24. TOWN OR CITY C ERK C M 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRIm) Jo n . asterson
{SEAL SIGNATURE" C. DATE OS/23/200 TIME MONTH YEAR MONTH
'-v-I MAI~ ~Be sh R Wappinger Falls, NY 12590 05:4~~ 05 24 2007 07 22 2007
STREET CITYrrOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED V. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE T ME M. DA YEAR 0 0 RELIGIOUS 1 IVIL
DATE AND AT THE TIME AND LL AM
PLACE INDICATED. ::1:3Q 90 OTHER, SPECIFY
COUNTY Dutchess
CITYfTOWN Wappinger
~~~~f; 1368 .
~5~~~R 40
1 . A. FULL NAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 097 28-9094
D. SOCIAL SECURITY NUMBER -
2. RESIDENCEA. New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r!1 TOWN 0 VILLAGE
AND W .
SPECIFY applncer
D. STREET ADDRESS 8 Gold Road
ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES ~ NO
08 / 20 / 1938
MONTH DAY YEAR
3. A. AGE 68
3B. DATE OF BIRTH
4. EMPLOYMENT
A. USUAL OCCUPATION Retired
B. TYPE OF INDUSTRY OR BUSINESS General Electric
5. PLACE OF BIRTH Poughkeepsie, (\Jew York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
A. NAME Georce V. Bennett
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Leona F. Bowne
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 3
9. ~~~~I.9~?R~'"FR~I(e<vr8us MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
2 0
B. HOW OlD LAST MARRIAGE END? (3) dDIVORCE (3) 0 ANNULMENT
C. DATE LAST MARRIAGE ENDED? 03/ 18 /
MONTH" DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? [rYES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITYICOUNTY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
1ST 07/25/1970 Gooding County, Idaho r1 0
2ND 03/18/2005 PoughkeepSie, New York r1
DEATH
o
(~ 0 DEATH
2005 '
YEAR
NAME (PRIm)
SIGNATURE"
DOH-98 (0312006)
o
...
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONLY)
'I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Susan Stilwell
FIRST MIDDLE CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT Speedlina
c. SURNAME AFTER MARRIAGE Bennett
(OPTIONAL - SEE REVERSE) 062 44 0623
D. SOCIAL SECURITY NUMBER --
12. RESIDENCEA. New York B. Orance
(STATE) (COUNTY)
C. CHECK ONE 0 CITY r5 TOWN 0 VILLAGE
~~CIFY Newburgh
D. STREET ADDRESS 1 0 Lancer Drive ZIP 12550
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILlAGE? 0 YES t1 NO
07 /27 /1951
MONTH DAY YEAR
~
11. A. FULL NAME
13. A. AGE 55
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Legal Assistant
B. TYPE OF INDUSTRY OR BUSINESS Law Firm
15. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME William Speed ling
B. COUNTRY OF BIRTH U S A
17. MOTHER
A. MAIDEN NAME Ruth Theresa Keenen
B. COUNTRY OF BIRTH U S A
16. NUMBER OF THIS MARRIAGE 4
YEAR
26. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. cou~II"rc-1lst8
C.
o CITY OF TOWN OF 0 VILLAGE OF
SPECIFY l'Ih.G If Pf.f,F'S' 1....-
NAME (PRIm)
SIGNATURE"