014
]
M
lD
N
T""
.:1
I.-
~
~ ~
.;u "'
Z Iii
::&
I.-
m
Ii.
>-G)
ro
en~
:Jfr:
o
~
~
60
~
g'-U
!!?m
<.90
~
~
ere:
~
"-tu
:;0
to
~"
>-
a:
UJ
o
UJ
a:
UJ
I
~
en
en
UJ
a:
o
o
"'
i::
o
UJ
"-
en
z:tz
~~3 w
~~~ t-
t-ffiz <(
gsdal U
~~SJ u:
z-
0~i:; ~
[toen II:
0>-> W
w~~ U
b~~
Z:::::i~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GRqOM k
Steven \I. Ba er
B HOW DID LAST MARRIAGE END? (3) 0 DIVOi5a (3) lJ~NULMENT 19~~ DEATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? .. ~ / / C. DATE LAST MARRIAGE ENDED? / /
MON1'f'I DAY YEAR MONTH DAY YEAR
o 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
1ST OW/fi~1'99~l.JISfe} E:'OiJ~'lYTFJ~WOYOSrk S~F SPO~E 1ST (MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) S~F SPO~E
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, at 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 marria st ~ ~
21 SIGNATURE OF GROOM ~ 2. SIGNATURE OF BRIDE ~ ~~\, a. f--l" '-R.._
23. SUBSCRIBED AND SWORN TO BEFORE ME USE CURRENT NAME 02/ 14/2002
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage New York Stat of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within W 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 'tl18lf~KJ. Morse 25. A. SOLEMNIZATION PERIOD BEGINS
NAME (PRINT)
Dutchess
COUNTY .
Wappinger
CITY!TO,*,~
DISTRICTI,)68
~~~'~~~R 14
NUMBER
1 A FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
"-
N
BIRTH NAME. IF DIFFERENT
c s~g~~~JN~LTE~~t:e~~sE091-62-6845
D SOCIAL SEK1~ylif8A< Dutchess
2 RESIDENCE A. (STATE)"; B. (COUNTY)
C ~~6CK o~deCP~fR' 0 TOWN 0 VILLAGE
SPECIFY 20 Ctlrdim~r Rotld Lor 87
D STREET ADDRESS
~
E IS R~~NCE WITHiN LIMITS OF CITY OR INCORPORATEmLAGE? /230 YES ~~~
3 A AGE 3B. DATE OF BIRTH ~ ~
MONTH DAY YEAR
4. EMPLOYMENT
l-
S;
<C
C
~u:
:'iu.
~<C
z
;:
o
t:
;:
i3
Auto Mechanic
A. USUAL OCCUPATION M 5 M Motor sports
B TYPE OF IND~TRY il1iUSINESS N .. rtt:
5 PLACE OF BIRTH oug eepsle, ew YO
(CITY, STATE,COUNTRY IF NOT USA)
6 FATHER R ld 8 k
ona a er
A NAME USA
B COUNTRY OF BIRTH
7 MOTHER MS.
A. MAIDEN NAME ary orel
USA
B. COUNTRY OF BIRTH 2
B. NUMBER OF THIS MARRIAGE
9 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV~RCE CIVIL A'lfULMENT
D1:fH
-'
ill
OJ
:;
::>
z
o
z
"'
~
w
w
go
<f)
w
en
z
w
U
::i
~
{ SEAL }
'-v-I
(THIS SPACE FOR STATE USE ONL Y)
t f1 11) /.,,;
tUn' J'~~''1
L 0 SUPPLEMENTAL FILE
FROM..-THE BRIDE- h
Theresa A. Ru e
~
11 A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B BIRTH NAME (MAIDEN NAME), f3~1(~rNT
C s~~~~~JN~~E~~t~~e~~sd)80-62 -0268
D SOCIAL s~~wTdtk Dutchess
12 RESIDENCE A. (STATE) ., B. (COUNTY)
C ~~6CK WapplngeYsFaW~ 0 VILLAGE
SPECIFY 46 Fumldindalc AvcJluc 12590
D. STREET ADDRESS ~
E. IS R~~NCE WITHIN LIMITS OF CITY OR INCORPORAT~LLAGE?). 5 0 Y~6'O
13. A. AGE 13.B. DATE OF BIRTH - ~
MONTH DAY YEAR
14. EMPLOYMENT Unemployed
A. USUAL OCCUPATION
B. TYPE OF IND~TR'''-OR ~INES~, rtt:
nronx New y 0
15. PLACE OF BIRTH '
(CITY, STATE/COUNTRY IF NOT USA)
16 FATHER Allen Ruhe
A. NAME USA
B. COUNTRY OF BIRTH
17. MOTHER S rI d
A MAIDEN NAME usan 0 an 0
lJSA
B. COUNTRY OF BIRTH I
1B. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A'l'rULMENT
DI(fH
TIME
MONTH
25 B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON
MONTH
DAY
YEAR
YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
STATE ZIP
27 TYPE OF CEREMONY /
o 0 RELIGIOUS 1 0"'CIVIL
1 :53 ~~ 02
15
2002 04
15 2002
28. PLACE WHERE MARRIAGE. OCCURRED ./.u~/
A. STATE NEW YORK B COUNT~
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) //
o CITY OF LJ TOWN OF ~VILLAGE OF
SPECIFY {A. )AiJ(JIii1>frU,. r::4
9 0 OTHER, SPECIFY
