156
:J
STATE OF NEW YORK
COUNTY Dutchess
Wanoinner DEPARTMENT OF HEALTH
CITYITOWN F. ~
~~~~~~T1368 AFFIDAVIT, LICENSE and
~G~I~J~R156 CERTIFICATE OF
1: AnY]O~-fetf h~ AffiCkWrr l:LflJ/M 0 MARRIAGE
FROM THE GROOM
Michael James
I STATE FILE NUMBER I
(THIS SPACE FOR STA TE USE ONL Y) /{3
131
20~2051 ~O2
Lo SUPPLEMENTAL FILE ~
FIRST
MIDDLE
11. A. FULL NAME
FROM THE BRIDE
Donna M. Sorinaer
FIRST MIDDLE' CURRENT SURNAME
1. A. FULL NAME
CURRENT SURNAME
8 BIRTH NAME, IF DIFFERENT
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE James
(OPTIONAL - SEE REVERSE) -1,:i 1-43-6769
D. SOCIAL SECURITY NUMBER ,~
12. RESIDENCE ANew York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN c1 VILLAGE
~~~CIFY Wappingers
D. STREET ADDRESSB Spnng Street
ZIP 12590
wi
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPOr}TED VILLAGE? 0
AGE46 13.8. DATE OF BIRTH 2t 03 /15
MONTH DAY
YES 0 NO
:t956
YEAR
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE069-62 9533
o SOCIAL SECURITY NUMBER' -. ~
RESIDENCE A. New York B. Dutchess
(STATE) v!.. (COUNTY)
C CHECK ONE 0 CITY 0 TOWN U VILLAGE
~~~CIFY Wappingers
l'! ":pr'ng SIre""t
D. STREET ADDRESS'" -" . .......
ZIP '12590
wi
E. IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 NO
04 /06 /1953
DAY YEAR
AGE49
3B. DATE OF BIRTH
MONTH
13. A.
EMPLOYMENT
A. USUAL OCCUPATION Computer Analyst
8. TYPE OF INDUSTRY OR BUSINESS I. 6. M.
5. PLACE OF BIRTHlymington, England
(CITY, STATE/COUNTRY IF NOT USA)
14. EMPLOYMENT
A. USUAL OCCUPATION Medicai Biller
B. TYPE OF INDUSTR~ OR BUSINESS Mobile ltfe Support
15. PLACE OF BIRTH Poughkeepsie, New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME Ronald James
B. COUNTRY OF BIRTH England
7 MOTHER
A MAIDEN NAME June Windsor
B. COUNTRY OF BIRTH Enq,land
NUMBER OF THIS MARRiAGE ;l
16. FATHER
A. NAME Donald Springer
B. COUNTRY OF BIRTJJ S A
17. MOTHER
A. MAIDEN NAME Janet Temple
8. COUNTRY OF BIRTJ!. S A
18. NUMBER OF THIS MARRIAGE 2
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19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
B. HOW DID LAST MARRIAGE END? (3)[j DIVORCE (3) l:!i~NULMENT_ (g), 0 DEATH B. HOW DID LAST MARRIAGE END? (3) i'5 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? 11 / II / 19!i9 C, DATE LAST MARRIAGE ENDED? 07 / 05 /1994
MONT~ DAY YEAR MONTItV DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO 0, ARE ANY FORMER SPOUSE(S) ALIVE? 0 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
iMONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST " '1111/1999 Goshen, New York c5 0 1ST 07/05/1994 Poughkeepsie, New York D' 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH 0 0 4TH 0 0
I, being duly sworn, depose and say, that to the best of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the marriage state. j 11 <~ .'
21. SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~ ~ ,
USE CURfjE NAME
23. I.
DATE
This license authorizes the marriage in New York S te of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies withi 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 CITY CL~RK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Glo . .Morse .
{SEAL SIGNATURE ~ --- ~, P Jt..1 DATE 09/25/2002 TIME MONTH
'-y-I M~Wafej,ush Rd, . appt er FaUs, NY 12590 12:03 ~~ 09
STREET CITYITOWN STATE ZIP
~~~R~~~Ri~~~ 'O~O~~~N~~E~ 26. SOLEMNIZATiON OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 ~ RELIGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND t'J,OO 0 q
PLACE INDICATED. ,r.' PM \ - \ - 0 9 0 OTHER, SPECIFY
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
1 0
DEATH
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DEATH
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29. OFFICIANT 7'>f\J' 0 L \, \ \ \
NAME (PRINT) N ,.::-, ~ t' 0....... . w; \ fA V'i\ ~
SIGNATURE ~ ~o \) ~\Y;~_ \ A~)JJ.^-t'.,~
MAiLING ADDRESS <::
~,\"'^ ~l-"t Mil.v~. ~\)tl.~~~I~
STREET CITYITOWN
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SIGNATURE ~ MtoD,1 [. ~~tQ
DOH-98 (11/9B)
TITLE
tv'\i ^;~te;-
Ie \\C\\OL
A. STATE NEW YORK B COUNTY \:>u1C\'€S. S.
C. LOCATION OF CEREMON~~:2 ~y/
(CHECK ONE AND SPECiFY J""",J
o CiTY OF 0 TOWN 0 DI ViLLAGE F
FtL\"s
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STATE
\2..J GO
SPECIFY \NC:\.yy\N}fr:s RI.\\s
DATE
31.
NAME (PRiNT)
SIGNATURE ~
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section
d13
Affidavit for
Correction of Marriage Record
COU NTY OF
bvtJ.t)
} ss:
State File #.
Groom: I
Bride: 6'
Date Completed:
~,J;J AM; .f"fJ.tA iJ i;c~
(Bride/Maiden Name)
r
STATE OF
Nt T...) '-1 f> )(
We,
~'I C t.f A-EL ~ INt is
(Groom)
and
being severally sworn, depose and say that:
1.
~ Ji1L1A/<l STA,6cl IPlrll'jtJ6f/IL..J MW
(Street ddress)
Marriage License issued by City[Town: iOc,..)/J c + WIrJlP; J.J(jf.Jc-S
tJ.
I:2.SrtJ
(Zip Code)
We reside at:
(State)
flA~
2.
3. Date of Marriage:
Ie tJ..:U ():L-
4. Error(s) appearing on record (list exactly):
a.
DA-r~ 0 f
~ i'l-, f.f
{)311~ /"S6
(I.M..-~ h-v; ctt_/ s ~A.~ J
b.
c.
5. Correct information as it should appear (list exactly):
a. t>A-"TC 0-( ~; ~ lit{ 03/1111 ~!,"(p
b.
c.
6. Documentation Submitted:
,f;hv'.tk c..u..-f\~1 CA.~.fW ~ ..J....) ,4 Iv-. stdlLi ;J6LIf--
a.
b. ~z. 0-+ ~;fz.t...-ILc'vt6 E C-EtL:n'fic:.vt'tt:. I-!JG/ft..-j 6IfT;,Jt;, ~&)f t,.;,;,;.ft- ~
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c.
This affidavit with supporting documentation is being made for the purpose of having the record of marriage show the
true facts and this affidavit will become a permanent record. The marriage record is filed with the Sta\e of Ne'/J York.
Subscribed and sworn to
(affirmed) before me this
~y~
~~~~
Signature of Husband
~ .~hv. ~
Signature of Wife {/
day of Mu:-:-~d
S7././z. a.L ~ ~J~
(.v.rf 01 evld<- t J
2>>af
Notary Public ~
MATTHEW E RITZ
Notary Public, State of New York
NO.01R16173194 ,
Qualified In Dutchess ~unn
~y Commission Expires 1c,'
NOTE: Certificate of Authenticity required for notary public outside New York S
DOH-1827 (05/2004)
(over)
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. NEW YORK '. ':;~
'. iJ.;~'~l6~;;t?';:~ER: Janet Joann T emp'e'i~ .;
~~~~f~WW~ona'd George Springer If!lt "
. ':', DATE F,LE6;iQ.$tj 9/1956 :;
. 'j:"t' j::., :;'.., ';" , :
;~.:f,"f;;;.;~~;.i:. ';1; h'.:';;' ~
, bcACAEqlSTRATION NO,: 248:
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This is' to certifY. 'that the' ~f.O~~ljo~: ~rJs.~rni8g ~~e birth o! .!,h!'l,gb.~V~:~~~~d :p.~ s ~ thi~ ~nd :~. 6cu~r ;; /~,:
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_~IISTATE OF NEW YORK
.,., DEPARTMENT OF HEALTH
Corning Tower
The Governor Nelson A. Rockefeller Empire State Plaza
Albany, New York 12237
Richard F. Daines, M.D.
Commissioner
Wendy E. Saunders
Executive Deputy Commissioner
December 10, 2008
JOHN C MASTERSON
TOWN CLERK
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS NY 12590
Groom:
Bride:
SFN:
MICHAEL JAMES
DONNA M SPRINGER
51902-2002M
Dear Town/City Clerk:
Enclosed is a copy of the marriage referred to by the above file in your office.
Correction to the original has been made based on:
[gI Affidavit
o Officiant's Statement
o Signature on original marriage affidavit
o Statement verified by City/Town Clerk
o Other: Supplemental
Please file this amended record along with the supporting documentation.
If you have any questions, please call us at (518) 474-2013.
Sincerely,
Linda Ortiz
New York State Dept. of Health
Vital Records Marriage Corrections Unit
P.O. Box 2602
Albany, NY 12220-2602
Enclosure
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COUNTY Dutchess
CITYfTOWN Wappinger
DISTRICT1368 .
NUMBER
REGISTER 156
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Michael James
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
"I
~nt if "~:1" Cd
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Donna M. Sprinqer
MIDDLE CURRENT SURNAME
..J
1. A. FULL NAME
11. A. FULL NAME
FIRST
FIRST
..
N
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE James
(OPTIONAL - SEE REVERSE) 131-48-6769
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A.New York B. Dutchess
(STATE) wi (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN LJ VilLAGE
~~CIFV Wap~ingers
D. STREET A~ Spnng Street ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VilLAGE? ~ YES 0 NO
13. A. AGE46 13.B. DATE OF BIRTH 03 /15 .1956
MONTH DAY YEAR
B. BIRTH NAME, IF DifFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSE069-62-9533
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. New York B. Dutchess
(STATE) .L (COUNTY)
C. CHECK ONE 0 CITY 0 TOWN U VILLAGE
~~CIFY Wappingers
D. STREET ADDRESS 6 spnng Street
ZIP 12590
."
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 NO
04 /06 /1953
MONTH DAY YEAR
3. A. AGE49
3B. DATE OF BIRTH
14. EMPLOYMENT
A. USUAL OCCUPATION Medical Biller
B. TYPE OF INDUSTRY OR BUSINESS Mobile Life Support
15. PLACE OF BIRTH poughkeepsie, New York
(CITY, STATElCOUNTRY IF NOT USA)
16. FATHER
A. NAME Donald ~ringer
B. COUNTRY OF BIR~ S 14.
17. MOTHER
A. MAIDEN NAME Janet Temple
B. COUNTRY OF BIRn/..!. S A
18. NUMBER OF THIS MARRIAGE 2
4. EMPLOYMENT
A. USUAL OCCUPATION Computer Analyst
B. TYPE OF INDUSTRY OR BUSINESS I. 6. M.
PLACE OF BIRTHLymington, England
(CITY. STATE/COUNTRY IF NOT USA)
5.
6. FATHER
A. NAME Ronald James
B. COUNTRY OF BIRTH England
7. MOTHER
A. MAIDEN NAME June Windsor
B. COUNTRY OF BIRTH En~and
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT
1 0
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19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVil ANNULMENT DEATH
1 0 0
B. HOW DID LAST MARRIAGE END? (3)'fj DIVORCE (3) 0 ANNULMENT (ID. 0 DEATH B. HOW DID LAST MARRIAGE END? (3) r5 DIVORCE (3) 0 ANNULMENT ~) P DEATH
C.DATELASTMARRIAGEENDED? 11 / 17 /19!19 C. DATE LAST MARRIAGE ENDED? 07 /05 /1994
MONTl;jl DAY YEAR MONTIV DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 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
lMONT~DA~ YEAR) (CITY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE iMONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST 11/1 "1::199 Goshen, New York ~ 0 1ST u7/05/1994 Poughkeepsie, New York rf 0
2ND 0 2ND 0 0
3RD 0 3RD 0 0
~H 0 ~H 0 0
I, being duly sworn, depose an say. thaI 10 I e besl 0 my Ie I al I e information S true and I al I declare that no egallmpe Imen! exists
as to my right to enter into the marriage state. I/J _
21. SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~ ~ ~ ~ .
USE CUR NAME ~
DATE 09/25/2002
This license authorizes the marriage in New York S te of. the bride and groom named above by any person authorized by New York Domestic
Relalions Law ~11 to perform marriage ceremonies withi New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
o If checked. this license is to be used only for the u ose of a second or subse uent ceremony.
~ 24. TOWN OR CITY Cl~RK 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Glo .".Morse
{ ~ ~
SEAL SIGNATURE ~ - , DATE 09/2512002
'-v-I M~Waf~bush Rd, appi er Falls, NY 12590 12:03 ~~ 09
TRE w T
I CERTIFY THAT I SOLEMNIZED 27. TYPE OF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE 0 If' RELIGIOUS
DATE AND AT THE TIME AND 0 t""I
PLACE INDICATED. \ . \ -,. 0 90 OTHER, SPECIFY
DEATH
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28. PLACE WHERE MARRIAGE OCCURRED
10 CIVil
A. STATE NEW YORK B. COUNTY Vu""c\-.e~ '1
C. lOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
V\i",i<:..ter
10 \\~ \01-
N Y \2.,j qo
STATE ZIP
31. WITNESS TO CEREMONY
~~~n~~~~T 'Re\!. ~~~o'" l. \A) \ \ \\t\.oM'.:l
SIGNATURE ~ ~o \.) ~~- \)~},.u.A.c.~ DATE
MAILING ADDRESSO::
~~""^ ,$.u.t-" AVthM. WA~~WI~ ~\ ~
STREET CITYfTOWN
:::::fEiE~
TITLE
o CITY OF 0 TOWN OF 111 VilLAGE OF
SPECIFY \NfiW,Ntr.s. ~\\s
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)