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Lynn Marie Goya
CLARK COUNTY CLERK
 

Document Details





Instrument Number
202402282001020

Record Date
2/28/2024

Book Type
NOT - NOTARIES

Book/Page

Instrument #
202402282001020

Number of Pages
3

Doc Type
OFF - MINISTER/OFFICIANT

Officiant Name
VAN DER WEGEN, DAVID

Date of Birth
1/15/1960

Type
Single

Processed By
COOKP

Status
Approved

Online Test Passed
1/30/2024

Background Check Req?
False

Officiant Residence Address 1
375 PARK AVE

Officiant Residence City
PEWAUKEE

Officiant Residence State
WISCONSIN

Officiant Residence Zip
53072

Mailing Address same as Residence?
True

Officiant Mailing Address 1
375 PARK AVE

Officiant Mailing City
PEWAUKEE

Officiant Mailing State
WISCONSIN

Officiant Mailing Zip
53072

Officiant Phone 1
(262) 309-3708

Officiant Email Address
BADSCHOONER@GMAIL.COM

Officiant Licensure Date
2/28/2024

Ceremony Date
4/19/2024

Party 1 Name
LEJA, DANIELLE

Party 2 Name
DI STASIO, NICHOLAS

Approved Date
2/28/2024

Certificate Expiration Date
4/20/2024