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COUNTY Dutchess
CITY/TOWN Wappinger
~~~~~c~ 13RB
~~~I~J~R 144
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
S~ntt r. T:::lr:::lnt
MIDDLE CURRENT SURNAME
:::t1~1C. ..-ILI: I"4UMCU:.M
(THIS SPACE FOR STATE USE ONL Y)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
~
A FULL NAME
Diedre E Spacone
FIRST MIDDLE CURRENT SURNAME
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT Cnleman
C SURNAME AFTER MARRIAGE Tarant
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER 103-54-0561
12 RESIDENCE A. N Y B Dutchess
C CHECK ONE (STA~) CITY [JoI'rOWN 0 VILLAGE (COUNTY)
AND P hk .
SPECIFY oug eepsle
o STREET ADDRESS 16 Twin Road
11 A FUll NAME
FIRST
BIRTH NAME. IF 01 FFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
o SOCIAL SECURITY NUMBER
2 RESIDENCE A N V
(STATE)
C CHECK ONE 0 CITY cY TOWN 0
AND P hk .
SPECIFY nllg eepsle
o STREET ADDRESS 16 Twin Road
ORf:l-~4-7f:l0?
B nl Jtr.he~s
(COUNTY)
VILLAGE
ZIP 12590
ZIP 12590
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VilLAGE? 0 YES r!I NO
MONQ~ / DQy4 / YE1R97
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE' 0 YES at NO
13.AAGE40 13.B. DATE OF BIRTH 10 /O? /1f:ln1
MONTH DAY YEAR
3. A. AGE 28
3B DATE OF BIRTH
14. EMPLOYMENT
A USUAL OCCUPATION Librarian
B. TYPE OF INDUSTRY OR BUSINESS Butterfield's Library
15 PLACE OF BIRTH Endicott New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Thomas Coleman
B. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME 8h:::lrnn ()y)(
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE 2
4 EMPLOYMENT
A. USUAL OCCUPATION ~:::ld\iti~ M:::lintpn:::ln~p
B. TYPE OF INDUSTRY OR BUSINESS Grubb & Fllis
5. PLACE OF BIRTH fc,WWfl~~~~~~~NON~Y' York
6. FATHER
A. NAME Philip T:::lr:::lnt
B. COUNTRY OF BIRTH I j S A
7. MOTHER
A. MAIDEN NAME Charlene Grant
B. COUNTRY OF BIRTH I J S A
8 NUMBER OF THIS MARRIAGE 1
19. 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 B HOW DID LAST MARRIAGE END? (3) O~IVORCE (3) 0 ANNULMENT
C DATE LAST MARRIAGE ENDED? / / C. DATE LAST MARRIAGE ENDED? 09/ 04 /
MONTH DAY YEAR MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO D. ARE ANY FORMER SPOUSE(S) ALIVE? O~ES 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 (MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
o 0 1ST 091041?001 Hartford, Connecticut 0 r:Y
o 0 2ND 0 [J
o 0 3RD 0 0
o 0 4TH 0 0
est of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
22. SIGNATURE OF BRIDE ~ /')~~/ 9: / 4-rr. GtJ1L-
" -t7' USE CURREN~
DATE 10/24/2001
by New York Domestic
9 PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
DEATH
o
o
o
(2) 0 DEATH
2001
YEAR
21 SIGNATURE OF GROOM
23 SUBSCRIBED AND SWORN TO BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New York Sta e of the bride and groom named above by any person authorized
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 purpose of a second or subsequent ceremony.
24 TOWN OR CITY CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
~
{ SEAL }
'-y-I
NAME (PRINT)
TIME
MONTH
AM
02:32'M
10
ZIP
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTyF!f7'NA--m
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF 0 TOWN OF p( VILLAGE OF
SPECIFY(?, J.-D St<' R i 11/&
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
1 ri CIVIL
ZIP
31 WITNESS TO CEREMONY
NAME (PRINT)
SIGNATURE ~
DOH-98 (11/98)
NAME (PRINT)
SIGNATURE ~