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2013 ,~,,a~,,,rM,,,IY.,,rw..,6',« .,w~.~ i ,~ ~ .. w~ D7'A October 21, 2013 Hon. Michael Leonard, Town Clerk Town of Wappinger 40 Middlebush Road Wappingers Falls, NY 1250 Re: Request for Copy of Marriage Certificate Dear Hon. Leonard, Please accept this correspondence as a formal request for two (2) copies of my Marriage Certificate. I am certified to request these copies as I am the bride, Dayna Trautwein nee Adamek, listed on the Certificate. Enclosed, please find the following: One (1) DOH-301 Application to Town Clerk for Copy of Marriage Record, one (1) copy of my Passport, and one (1) check for $20.00 made payable to Town of Wappinger. Please note that my Passport still reflects my maiden name, Dayna Adamek. In addition, this letter has been duly notarized by a notary for the State of Colorado, as my husband and I now reside in Broomfield, CO. At the time of application for our marriage certificate, we lived at 303 Town View Drive, Wappingers Falls, County of Dutchess, iV1,12590. Please contact me immediately for any issues that may arise. I can be reached via telephone at ~~ 661.1186 or via email at Dayna.trautweinCa?gmail.com . Thank you for your time and attention to this matter, as it is greatly appreciated. Sincerely, Sworn to before me T~iis,~,~day of October, 2013 - - JAMMES MARRUFO Notary Public State of Colorado Notary ID 20044043857 MY Commission Expires Jan 28, 2017 nttps:frmail-anachn~er~tgoeg~eusercc:ntentcomlattachmentiulOlsl?view=a. #=X38238,5t36~48&sads=ahcZ7iT~dchCF>hbb"~!<cescwn~.~KesnO&sadssc=l iOJZi/~3, 1.52 Ptv1 Page 't of 2. Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH ~;~ Records section for Copy of Marriage Record Searcl, and t;a, ~ Fee sto.oo ~~ A Certfication, an abstract from the marriage record issued under the seal of the Health Department, ir>chides the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification maybe used as proof that a marriage ocxurred. Seem and Certified Copy Fee st 0.00 ~~ A Certified Transcript includes atl of the ilerrw or information occurring on tl~e orig~al record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed irdorrrtation may be required such as: passports, veteran's benefits, court proceedings, or settlement of an estate. PLEASE PRINT OR TYPE Name (Fusf) (Midge) (LasQ Name _ (First) (Middle) (Last) of Groom ~n d rtw G-v+-no~n~ qv c~ of Bride ~G nA Mari ~ dAme~lL, Groom's Age Bride's Age ~1 BirlhDate of a ~ .~ I a ~0 &~ ~ ~P' $ l ~ ~' Residence (County) (State) Residence (County) (State) 0 oom f3' ,vim F'e Id GO Bide ~ ~~,fi~ td ~ Date of Marriage ff Bride Previously 5 ~ ~ ~ 13 ~ S I Married. Stale Name N I ~ earch Ussd at That Time Plaice Where place Where Issued Was Twr ~ Wei i r e /' Pe1. ~"~ Im ~ dd ~ ~wv~, N For wheat purpose is inforrrration required? What is your reletiorrstrip to person whose record is requested? Soci ~ I SP G ~.2.i ~ name Ckt G Yl 9 C ~ K ~• state "self.' ~~ ~ ~, ~aSsQo•--~- Chav~q~ In what c~paaty are you acting? ff atlomay: Narne and relationship of your cfieM to persons .~' 1 ~- whose marriage rerxxd is required. S' Date h ~~ 113 Address icaM Please print name and address where recoM is th be sent. Dayv,a ~dame.'~L T~raynC A-UIam~L 1a~vy King ~-~ Ia~~4 K,~9 S~e+ ~D,m~;eld~, C~ S~oao (3~nm-F tld, Co ~SO~~n DOH-sot (sly) (PLEASE SEE REVERSE SIDE) Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Search and ~ Fee $1000 I ~~ and ^ Fee $10.00 Certification p~ cepy Certified Copy per copy A Certification, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of ~e bride and groom. A Certification may be used as proof that a marriage occurred. A Certified Transcript includes all of the items of information occurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or se[dement of an estate. .. e ~~ ~,:; 8 PLEASE PRINT OR TYPE Name (Prat) (Middle) (Last) Name (F~ (Middle) (Last) Groom ~ ~ ~ 4 Yl Bride ~ ~~ ~ 1 ~ ~ Groom's Age to of i „ r ~ ~ i ' Bride's Age e of ' Q' 1 l Birth ~ J County) E~~ (State) Residence ( My) (State) Residence (Cou rr~ U11v~ VV 1 ~ ~~ ~S t`~~ ~, ~ Q, G '1Qw"~(1 '~' v n ~ B . i room f 0 I 1 ( de Date of Marriage ff Bride Previously or Period Covered ~ ~ 1 ~ ~ ~ Married, State Name b Search Used at That Time Place Where License Was `,~` ~~ n ~S V y Place Where Marriage Was C Performed ~ Issued For what purpose is information required? What is your ip to whose record is requested? r~~'~~ Q ~ ~ ~~~ Y ~ r ~ R If self, state'sMf 1 In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. Sig tore of Appl' fr Da`te "~ Q I I~I U~ 0 l~ Address of Appl ~~~ O ' Please print name and address where record is to be sent. ~1 ~ QJ,~~r~, r - ~ r~ s ~oa~s ~~ ~ a5go ~~ ~ DOti-301 (3/~i) (pLJ=ASE SEE REVERSE SIDE) Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH V~ Records section for Copy of Marriage Record search ana ~ Fee s~o.oo certification P~ ~Py A Certification. an abstract tram the marriage record issued under the seat of the Health Department, inck~des the names of the contracting parties. their residence at the time the fic:er~se was issued as weN as date and place of batt- of the bride and groom. A Certification may be used as proof that a marriage ocxiured. search and ~;~ ~,y ® Fee st o.oo P~ ~Py A Certified Trar~acxipt indudes aN of the items of intiorrnation occurring on the original record of the marriage. A Cerfified Trenscxipt maybe needed where proof of parentage and certain other detailed iMorrna6on may be required atxh se: passports, veterans benefits, caul proceedings, or aetdernent of ~ estate. PLEASE PRINT OR TYPE Name (First) (Middle) (Lasq Name (FrsQ (Midge) (~ A Groom I " C ~ ~ ~ Bride r ' ~ ` L ~r-' Grain s Age or Date of ~ ~ p ( ~~ Bride's a D~~ ~ ~~~~/,~+~ D lJ Birth B~ RB$+dence (County) (State) Residence (Co unt y ) (State) Groom ~ ~(',, v~ Bride - ~ ^ ~ ,, ~ ~ ~~~ Date of Marriage or Period covered ~ ~ ~ '~ ~ ff Bride p~~y Married. strrfe Name search Used at That Time Place Where Place Whero _ l was OI~J/J D~ ~~ ~t' I~Cz~12S ~ I~T~ u ~ L, ~ For what purpose is intorrnation required? N ~~-~ ~~il ~-~ C In what capacirty~arre' you acting? Whet is your relationship to Person whose record is requested? ff self, state 'bell.- S~ ff aleontey: Name arts reiatiorrship of you diets to persons vrlwee marriage record is raiqur+ed. Signahue «1a1~ Address of Applicant Please print name and address where record is to be sent. I(~ C,L~~~:r,A~,J ~ I~I~C~-[AFL r~~r kl-~S l0 Cc..~t1~1,~1~,1~ !~. ~~~ ~~~t,~G~~)~ ~ ~ I~~~ ~ ~at~c~ N~~~~ ~ ~ I ~ ~ DOH-301 (3/9Gi) (PLEASE SEE REVERSE SIDE} ~ CLASS R~ .;~ N~tY. t~# "~;,;.a, f~~~ z: 5 i1-06-18 p~t~ Where to Apply for Record of Marriage 1. License Issued in New York State (Outside of New York City) Year of Marriage * 1880 to present * 1880 - 1907 and license issued in the cities of Albany, Buffalo . or Yonkers Apply to: Certification Unit Vital Records Section P.O. Box 2602 Albany, NY 12220-2602 Buffalo: City Clerk, City Hall, Buffalo, NY 14202 Albany: City Clerk, City Hall, Albany, NY 12207 Yonkers: City Clerk City Hall Yonkers, NY 10701 2. License Issued in New York City Apply to the Borough office of the New York City Clerk that issued the marriage license. The location of these offices follows: Manhattan - Municipal Building, New York, NY t 0007 Brooklyn - Municipal Building, Brooklyn, NY 11202 Bronx - (Records for 1908-1913 are on file with the Manhattan office) 1780 Grand Concourse, New York, NY 10457 Queens - (Records prior to 1898 are on file with the New York State Department of Health) 120-55 Queens Boulevard, Kew Gardens, Jamaica, NY 11424 Richmond - (Records prior to 1898 are on file with the New York State Department of Health) Borough Hall, St. George, Staten Island, NY 10301. PLEASE NOTE: Records of marriages in areas of the present City of New York, which were not part of the city at the time of marriage, are on file with the State Department of Health. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Search and I / I Fee $10.00 ~ h ~ ^ Fee $10.00 Certification LJ ~ spy ~ ~ Per coPY A t;.ertification, an abstract from the marriage record issued A Certified Transcript includes all of the items of information under the seal of the Health Department, includes the names of occurring on the original record of the marriage. the contracting parries, their residence at the time the license was issued as well as date and place of birth of the bride and A Certified Transcript may be needed where proof of groom. parentage and certain other detailed infommation may be required such as: passports, veteran's benefits. court A Certification may be used as proof that a marriage occurred. proceedings. or setbement of an estate. PLEASE PRINT OR TYPE Name (Prat) (Middle) (Last) Name (Fast) (Middle) (Last) ~ Groom ~ ~ ~ of Bride I << S ~ ~'"~' Groom's Age Bride's Age or Date of Birth ~/ 0:5 / or Date of Birth 4`7 / £f S' Residence (County) (State) Residence County) (State) `~~ Groom I ~ c, t-( 5S '~ -~ of Bride ct-r-c. ~ cf 5_`~ ~ Date of Marriage ff Bride Previously or Period Covered Married, State Name b Search \ u i 3 Used at That Time Place Where Place Where . License Was (~ c~ Marriage Was Perfom~ed ~ t-~~~ c3t`~ ~~ ~ 1~? .~ Issued Application to Town/City Clerk for Conv of Marriaae Record DOH-301 (8/~i) (PLEASE SEE REVERSE SIDE) Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Certfi tiom a Fee $10.00 Ca~rh'fiedh spy ^ Fee $10.00 ~ spy Imo' copy A Certification, an abstract from the marriage record issued under the seal of the Health Department. includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and 9~• A Certification may be used as proof that a marri~e occurred. A Certified Transcript includes aN of the items of information occurring on the original record of the marriage. A Certfied Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceeding, or settlement of an estate. PLEASE PRINT OR TYPE Name (Prat) (Middle) (Last] Name (Fast) (Middle) (Last) Groom M+q~GU A~TDWI~~ 'J~V4N CII Bride '~OSA ~fh21~~ 11A1C~u7~--~ Groom's Age Bride's Age or Date of J q ~ D 3 l G ~ ~ or Date of 8 _ 3 ~ _ ''~~ t Birth Birth Residence (County) (State) Residence (Courriy) (State) of 3~'7 Flo,~rJE~s i2o Groom fisl~ N t ZS Z L{' ~ 30`7 Nor-~+~ 1en Bride B S I ~Lt ~L N l 2S 2 Date of Marriage ff Bride Previously or Period Covered ~ U ~~-Pl 2~~ S Married. State Name Search Used at That Time Place Where Place Where Was V~(hQQI aJC~Cs2S `~t~t.1~1 F~6~1.(' ~Wffi w~PP I IV6~L1' ~dWtil ~ L( Issued For what purpose is information required? What is your relationship ro person whose record is requested? COU ~~ . If self. state'self.' In what capacity are you acting? ff attorney: Name and relationship of your cl~nt ro persons ~ S ~~ ~ ~S ~~~ whose marriage record is required. Signature of A t Date ~ ~ ~~~--~~ ~12 - Z -13 Address of App "cant Please print name and address where record is ro be sent. DON-JOf (~). (PLEASE SEE REVERSE SIDE) Application to Town/City Clerk NEW YORK STATE DEPARTMENT OF HEALTH for Copy of Marriage Record Vital Records Section Search and Certfication ^ Fee $10.00 I Search and Certified Copy P~ cePY ~ ~/( Fee $10.00 ~~J per copy A Certfication, an abstract from the marriage record issued under the seal of the Health Department, includes the names of the contracting parties, their residence at the time the license was issued as well as date and place of birth of the bride and groom. A Certification may be used as proof that a marriage oxurred. A Certified Transcript includes all of the items of information oxurring on the original record of the marriage. A Certified Transcript may be needed where proof of parentage and certain other detailed information may be required such as: passports, veteran's benefits, court proceedings, or setgement of an estate. PLEASE PRINT OR TYPE Name First) (Middle) (Last) U _ ~~ ~ I ~~~~ l Name (Fast) (Middle) ` (Last) ~~~I,S~ Gt I~ (~'Se /'l~/1K~IJ~,~~U'r Groom i'~ Bride Groom's Age or Date of ~g Bride's Age ~\ or Gate of ~ tJ Birth Birth Residence (County) ~ (State)d) -' ~ ~ ~ " ~~ ~ ~ ~ Residence (Coun'ty) ~p (State) ~~~ ~ N~ ~Z~/C. Y Groom Bnde Date of Marriage ff Bride Previously or Period Covered Married, State Name b Search Used at That Time Place Where ~e Was ~ p, ~t ~ ~ l 1s ~ Place Where P ffi ~ ~~~ ~ ~~- s Forwhat purpose is information required? In ~~ /~ .~ /'~~ ~~f~ What is your relationship b person whose record is requested? If self, state'setf.' a _ In what capacity are you acting? If attorney: Name and relationship of your client to persons whose marriage record is required. 8igna of Applicant Date ~~~/~~! A~~ ~ of gpplU Ie ~ ~U~ $ 7 ~ K P,llease Print name and address where record is to be sent ~G( Yl~ ~~~9~,c%eeP~~ rv~ ~a~o~ DOH-~of (s/a3) (PLEASE SEE REVERSE SIDE) ~~ ~~ ~~ NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Sedian Application to Town/City Clerk for Copy of Marriage Record TYPE C)F R~COR© L~E~REI~ t;ERt~r dumber of Copies) Search and Fee $~ 0.00 Cert~ed Transcri t ^ per co Search and Fee $10.00 C tifi d C ^ p py er e opy per copy A Certified Transaipt is an abs7act from the manage record issued under the A Certified Copy indudes all d the items of information occumng an the original seal of the townloity detlr. It indudes the names d the oorrtrading parties, their record of the marriage. residence at the time the Goenae was issued, date and place d rnaniage as well as date and place of birth of the bride and groom. A Certified Copy may be needed where proof of parentage and certain other detatled itrfarmartian may be required such as: passports, veteran's benefits A Certified Transaipt may be used as proof that a marriage occurred. , court prooeedrngs, a settlement of an estate. Bridelt3roort~ISpouse Name (as recorded on marriage license): Date of Birth: . p-.y.er.» ~~y Fr.r i" tadu. tst ~ araN.~. ~ If Previously Married, State Name Used at Time: • Residence (at time of marriage): 15y~ ~~ Q ~~~ Frar IBd~~ !a!f Bride/Gr~xrtlS~o-1~e Name as recorded on mama license ( 9e ) Date of Birth: ^L~,,Q Q~ ~o, fa.+w.rr..a~ { i L , ~ - ry,r . c ,tree. ,.,e areu rrr~. „ ~ a If Previously Monied, State Name Used at that Time: Reside~rce (at time of marri ): ~y -~e~,~ ~.~ r•.,r ~. r,.r ~ fee ~~,~' ~~y Id~,~~ aea. Marriage trifcarrllaton Place Where Marriage License Was Issued: Place Where Marriage Was Perforated: Marriage Certificate No.: Local Registration No.: F-~ I~~d Tewr x + Tows r- \ } Purpose for wh rd is required: Date of Marriage or Period Covered by Search: N ~ C r~~M o s~~ In what capacity are yo ting?: What is your rr~ationship to parson wfrose record is requred? f~•I~imml (If self, state "SELF .) stab ~ ~.~ah:pP.rinaP (^.Ied/my/ If attorney, give name and relationship of your client to person whose record is required: Signature of Applicant Date: ApplicarrYs Phone Number. Name of Applicant: Please print name and address where record is to be sent: Address of Applicant: ~1' irate ZIP C+b' Stator ZIP V V I IvN 1 ~o/ 1 1) rOtlO 1 VI G