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046 z z a: 0 W :oJ f= f- .... W '" a: N <( f- Z (f) ::; () :;0 W ::; 6 u:: ~ ,./..., f- (f) z t= ': '" u. \ . 0 0 a: H: (f) W STREET CITY/TOWN 0 >- '" () Iii 0 30 WITNESS TO CEREMONY t- O NAME (PRINT) Z ;;:: SIGNATURE ~ DOH-98 (11/98) ] -,.- n ffi if) t:'.~ .::.i L- 0 ~- w --. f- '" ;;. t- <J) Q) ~ "'-- !!! >-rIG .... ~ :> <IV) ~ <( C w u:: iJ; '" ;R j LL > <( ~ z " '4!:- 0 lL-" r f- >- (f) _ t- ~ U U1~ C5 I ..- ""'- sm" ~ 'D w f- ~ f= a: w 0 w a: w a: I w " al (f) " (f) :J W Z a: 0 0 Z 0 '" '" S i:: a: 0 t- W <J) "- (f) o COUNT-Rutchess CITY/TowJI'!'appinger ~~J~kCR1I368 ~G~I~J~l46 STATE OF NEW YORK DEPARTMENT OF HEALTH AFFIDAVIT, LICENSE and ) CERTIFICATE OF Y' MARRIAGE v FROM THE GROOM Randall D. Simoniette I STATE FILE NUMBER I (THIS SPACE FOR STATE USE ONL Yi iJ~ I Jr~ ~~Lf~1 L U SUPPLEMENTAL FILE -.J A FUll NAME V FROM THE BRIDE 1 h FUll NAME Linda M" Diringer v / FIRST MIDDLE CURRENT SURNAME / 8 BIRTH NAME (MAIDEN NAME)g. DIFFERE~~reg~. C SURNAME AFTER MARRIAGE-::oimometle-dmnger (OPTIONAL. SEE REVERSEfl7~50-9818 D SOCIAL SECURITY NUMBER U ~ 12 RESIDENcEl"ew York BDutchess C. CHECK ONE (STA~) CITY"D TOWN 0 VILLAGE (COUNTY) AND W " SPECIF'-. applnger D STREET ADDRES?1 Daisy Lane FIRST MIDDLE CL N 8 BIRTH NAME. IF DIFFERENT C SURNAME AFTER MARRIAGE (OPTIONAL SEE REVERS561 96 8685 D SOCIAL SECURITY NUMBER -- 2 RESIDENCE ANew York B Dutchess (STATE) ~ (COUNTY) C CHECK ONE 0 CITY 0 TOWN 0 VILLAGE ~~~CIFY Wappinger D STREET ADDRES~'l Daisy Lane ZIP 12590 E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VillAGE? 0 YES....O NO ",22 /1947 DAY YEAR ZIP12590 o YEs'''b NO tH54 3 A. AG~4 07 E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VillAGE? 13. A. AG.ft7 13B DATE OF BIRTH 07 m MONTH DA Y 3B. DATE OF BIRTH YEAR MONTH 4 EMPLOYMENT A. USUAL OCCUPATIONBoat Buiider B. TYPE OF INDUSTRY OR BUSINEs~toml King Marine Center 5. PLACE OF BIRT~av City. Michiqan (CITY. STATE/COUNTRY IF NOT USA) 6 FATHER A NAME Randall Simonielte B COUNTRY OF BIRTJJ S A 7. MOTHER A MAIDEN NAME Marietta Hardy 8. COUNTRY OF BIRTHU S A NUMBER OF THIS MARRIAGE2 14. EMPLOYMENT A. USUAL OCCUPATlmpurgical Dentai Assistant B. TYPE OF INDUSTRY OR BUSINESJ:!r. Frank 15. PLACE OF BIRTPouqhkeepsie. New York (CITY, STATE/COUNTRY IF NOT USA) 16. FATHER A. NAM~ohn GreQa B. COUNTRY OF BIRTU S A 17 MOTHER A. MAIDEN NAMcElizabeth Spiegel B. COUNTRY OF BIRM S A 18. NUMBER OF THIS MARRIAGE 2 19. PREVIOUS MARRIAGES A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT o 0 9 PREVIOUS MARRIAGES A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY DIVORCE CIVIL ANNULMENT 1 0 B HOW DID lAST MARRIAGE END? (3')'0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH C DATE LAST MARRIAGE ENDED? 02 /24 /1994 MON~ DAY YEAR D. ARE ANY FORMER SPOUSE(S) ALIVE? 1] 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 1ST02f24/1994 Kingston. Np.w Yot1c 1J 0 2ND 0 3RD 0 4TH 0 I, being duly sworn, depose as to my right to enter into the m DEATH .. I DEATH o B. HOW DID lAST MARRIAGE END? (3) [J DIVORCE (3) [-j ANNULMENT (2) DEATH C DATE LAST MARRIAGE ENDED? 03 / .18 /t 991 MONTH ...tDA Y YEAR D ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES TJ 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 iJ 1ST 0 ~D n 3RD 0 4TH 0 n f that the information I provided is true and that I declare that no legal impediment exists [J 21. 22 SIGNATURE OF BRIDE ~ ' 23 authorized by New York Domestic w (/) Z W () :::i TIME MONTH YEAR MONTH YEAR DATED4/29/2002 n e Falls NY 12590 C Y/r WN STATE ZIP 27. TYPE OF CEREMONY AM .t :13 PM 04 30 2002 06 28 2002 28. PLACE WHERE MARRIAGE CCURRED o 0 RELIGIOUS 9 0 OTHER. SPECIFY 1 n CIVIL RK B. COUNTY A. STAT TITLE LOCATION OF CEREMONY (CHECK ONE AND SPECIFY) o CITY OF C TOWN OF 0 VILLAGE OF SPECIFY