108
~
"-
N
>- I-
~ :>
~ <I:
'" C
5 ~ u:
'f...::tSu.
~~~<I:
QN~
~~g
t;s;~
a 0
w
a:
w
:i?,...,
ii:,...,
-..-I
~
c:
(/J
~
u:
;::...::t
5......
o
w~
a:
':l!0'I[[
;: III
(j) . ~
~ .u z
:sp:::j1
'" ...
<"""~
~O'\~
oot;;
~......
cn
ZIZ
'5!::Q W
ti;~~ I-
~ffiz <I:
3dal 0
~q~ ii:
u. i=
o a:
w
o
~.~
wcnO
t-ffiU')
i~~
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
David J. Duckwitz
1ST
n 2ND
C 3RD
u 4TH
ledge and belief that the information I provided is true and that I declare that no legal impediment eXists
]j...;;...J n tJOl ,L\(Cldt-
USE CURRENT NAM~
23. Clerk DATE July 12. 2000
This license authorizes the marriage in New ork State of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perform marriage ceremonies within New York State. THIS LICENSE VALID IN NEW YORK STATE ONLY.
= 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) ~ Elaine H. Snowden. Town Clerk ..
{SEAL SIGNATURE ~n~ U Su. <7\...A1 L DATE 7/12/00 TIME MONTH DAY YEAR MONTH DAY
'-..,-I M~L~~.AD~~~ 324 Wappingers Falls. NY 12590 3: 30 ~~ 07 13 00
STRE CITYfT WN STAT ZIP
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY ~
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE TIME M DAY YEAR 0 C RELIGIOUS 1 _ CIVIL
DATE AND AT THE TIME AND
PLACE INDICATED
COUNTY Dutchess
.
CI"OJITOWN Wappinger
~~~~kc~ 1368
~5~I:J~R 108
A. FULL NAME
MIDDLE
CURRENT SURNAME
FIRST
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D. SDCIAL SECURITY NUMBER
2 RESIDENCE A New York
. STATE,
C CHECK ONE = CITY ~ TOWN 0
AND -
SPECIFY Wapp~nger
D STREET ADDRESS f'~~~k!h9N~14 ZIP 12524
E. IS RESIDENCE WITHIN UMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 25 NO
3. A AGE 29 3BDATEOFBIRTH July /10 /1971
MONTH DAY YEAR
088-72-3373
B. Dutchess
(COUNTY)
VILLAGE
4. EMPLOYMENT
w
>-
...
>-
en
A. USU.~L OCCUPATION Car1'e!l'.:er
B. TYPE OF INDUSTRY OR BUSINESS Sub- Contractor
5. PLACE OF BIRTH Poughkeepsie New York
CITY. STATE,COUNTRY IF NOT USA)
6. FATHER
A. NAME Bruce L. Duckwitz
8. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME
B COUNTRY OF BIRTH
Janet J. Doxsey
USA
Second
B_ NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
8. HOW DID LAST MARRIAGE ::ND' 13tE DIVORCE (3) 0 ANNULMENT 121 - DE.~TH
C. DATE LAST MARRIAGE ENOED? Dec. /14 /1999
MONT1:l,. DAY YEAR
D. ARE ANY FORMER SPOUSE,S) ALIVE? EJ YES D NO
DEATH
10. IF PREVIOUSLY DIVORCED OR ANNULED. PROVIOE THE FOLLOWING INFORMATION
OA TE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY YEARI 'CITY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
1ST 12/14/99 poughkeepsie , NY Xi
2ND
3RD
4TH
I. being duly sworn, depose and
as to my right to enter into the
21 SIGNATURE OF GROOM.
w
en
z
w
o
:J
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
~
~ ?/')-,,~.i)
L
~
D SUPPLEMENTAL FILE
FROM THE BRIDE
Dawn M. Hoysradt
11. A. FULL NAME
FIRST
MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT Snyder
c. SURNAME AFTER MARRIAGE Duc kwi t z
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 0 '14 '1R-4040
12 RESIDENCE A New York B. Dutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY ~ TOWN C VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 1 Qg~., ~~ ~# 14
E. IS RESIDENCE WITHltKib~M~r'YtR I~C~RPORATED VILLAGE?
13. A. AGE 11 13_8. DATEOFBIRTH.June /01
MONTH DAY
ZIP 12524
:= YES E NO
A969
YEAR
14. EMPLOYMENT
A. USUAL OCCUPATION
naker
8. TYPE OF INDUSTRY OR BUSINESS Grand Union
15. PLACE OF BIRTH Massena , New York
(CITY. STATE/COUNTRY IF NOT USA)
16. FATHER
A_ NAME Larry J. Snyder
8. COUNTRY OF BIRTH USA
17. MOTHER
A. MAIDEN NAME Sylvia P. Crump
B. COUNTRY OF BIRTH USA
18. NUMBER OF THIS MARRIAGE
Second
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
One
B. HOW DID LAST MARRIAGE END? dt: DIVORCE ,31:= ANNULMENT 12) - DEATH
C. DATE LAST MARRIAGE ENDEO? Feb. /25 /2000
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? ~ YES:] NO
DEATH
20. IF PREVIOUSLY DIVORCED OR ANNULEO. PROVIDE THE FOLLOWING iNFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY. STATE-COUNTRY. IF NOT USA) SELF SPOUSE
2/25/00 Poughkeepsie NY ~
22. SIGNATURE OF BRIDE ~
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
YEAR
9
10
00
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK 8. COUNTY Wili6"S
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) /
o CITY OF 0 TOWN OF r/ VILLAGE OF
SPECIFY