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COUNTPutchess
CITyrTOW~appinger
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DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Don A. Morse
CURRE::NT :::'-URNAM~
(THIS St'Al;t: rUM" I A I t:. 110t::. l)/'JL r J
('Jft(
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i' It; , ?J t7)
L 0 SUPPLEMENTAL FILE
~
FROM TI-lE BRJDE
Linda M, Fnedenberg
A FULL NAME
11. A. FULL NAME
FIRST 1frr'enbur
B BIRTH NAME (MAIDEN NAMElt1~{S~NT 9
C S~~~~~N~~E~~t~~C~~sE{}90-50-7 167
o SOCIAL S~CjJRITY It~BE~ 0 ,d h
Nf!W T Qf!(: 'luC. ,e55
12 RESIDENCE A' - -- B.
(STATE)" (COUNTY)
C CHECK Q~ [] CITY 0 TOWN 0 VILLAGE
AND wappinger
SPECIFY lOC Chelse~ Rid t: Olive
o STREET ADDRESS Y
.
FIRST
MIDDLE
CURRENT SURNAME
0-
N
BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSDt 18-58-3046
D SOCIAL SECURITY NUMBER 1
2 RESIDENCE ANew York B Dutche5s
(STATE I J (COUNTY)
C CHECK ONE 0 CITYu TOWN 0 VILLAGE
~~~CIFY Wappinger
o STREET ADDRESS Chelsea Ridge Drive 20c
12~90
ZIP
Y1)fflONO
YEAR
E IS RE4DENCE WITHIN LIMITS OF CITY OR INCORPORA TljjLLAGE? na 0
13. A AGE 1 13.B DATE OF BIRTH L
MONTH OA Y
14. EMPLOYMENT S If E I d
e - mp oye
A. USUAL OCCUPATION Dixit: Cr t:~liulIs
B TYPE OF INDlt:il!'Y OFLBUSI/'JE~. . k
t(n1neDeCK New Tor
15. PLACE OF BIRTH '
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER ~ b
Roger Ruen urg
A. NAME USA
B. COUNTRY OF BIRTH
17. MOTHER M F .
A MAIDEN NAME ary anmng
B. COUNTRY OF BIRTHU S ~
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DI10RCE CIVIL A~ULMENT
D"ljTH
3 A. AGe41
04
3B. DATE OF BIRTH
MONTH
DAY
4 EMPLOYMENT
A USUAL OCCUPATION Maintenance Technician
B. TYPE OF INDUSTRY OR BUSINESSGap Inc.
5 PLACE OF BIRTJ:!rooktyn, New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME Donald Morse
B. COUNTRY OF BIRTH USA
7 MOTHER
A. MAIDEN NAME Joan Caffrav
B COUNTRY OF BIRTH USA
8 NUMBER OF THIS MARRIAGE 3
9 PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
2 0
DEATH
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B HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (310 ANNULMENT 100 DEATH B. HOW DID LAST MARRIAGE END? (3) 0 DIVOP.f2 (3) 1l~NULMENT19~ DEATH
C DATE LAST MARRIAGE ENDED? 11 / 08 /20 1 c. DATE LAST MARRIAGE ENDED? _~ / /
MONTl,lI' DAY YEAR MONT"," DAY Y~',i1
o ARE ANY FORMER SPOUSEIS) 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
(MONTH. DAY. YEAR) (CITY. STATE/COUNTRY, IF NOT USA) SELF SPOUSE (MONTHi!DAYgYEAR) (CITY...:'lTATElCOUI'HRY.1f NOT ~~A)..t. SELF SPOYji=
1ST 04106/1981 poughkeeosie. New York i5 So 1ST 12100/1 99 Poug,\KeepSle, New TO", 0 0
2ND 1'1/08/200'1 Pouqhkeepsie, New York 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 a riage s '---t' ^ ---.
21 SIGNATURE OF GROOM ~ 22. SIGNATURE OF BRIDE ~ ~ m ~-~
23 SUBSCRIBED AND SWORN TO BEFORE ME USE C RRENT NAME 01/0112002
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies wit n 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 CLERK 25 A SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) Gloria J. Morse
{ J // (' '7/]",,4 01/0112002 TIME MONTH DAY YEAR MONTH
SEAL SIGNATURE ~ ~A -,,//Id'~~TE
'-..-' MA~lfi'lOO~df~bush Rd,~ppinJser falls, NY 12590 01 :45 ~~ 01 08 200 03 08 2002
STREET CITyrrOWN STATE ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY, ./
~~~sM~~~~g~B~vt:5'N PTE:E TIME MO DAY YEAR 1 ~VIL
DATE AND AT THE TIME AND I ~ 4M'
PLACE INDICATED ,(' r- PM
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YEAR
28. PLACE WHERE MARRIAGE OCCURRED ~
A. STATE NEWYORK B. COUNT~V AD""l
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~N OF~ C' VILLAGE OF
SPECIFY --\:t '/ J).tI C,.~ {I
31.
NAME (PRINT)
SIGNATURE ~