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Dutchess
COUNTY
wappinger
CITYITOWll
DISTRICT 1 368 '
NUMBER
REGISTER 1 L9
NUMBER
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Francis Leonard Ludwig, Jr
MIDDLE CURRENT SURNAME
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kristen Noel Kover
-.J
L A. FUll NAME
11. A. FUll NAME
FIRST
MIDDLE
CURRENT SURNAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL, SEE REVERSE)093-64-0476
D. SOCIAL SECURo/ NUMBER
2. RESIDENCE A. N B, Dutchess
(STATE) ~ (COUNTY)
C. CHECK ON~I 0 cr II TOWN 0 VILLAGE
~~~CIFY I-' easam a ey
11 { Oholloran Circle
D. STREET ADDRESS' ZIP
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VI~GE? cP
3. A. AGE 29 3B. DATE OF BiRTH 1 / 1
MONTH DAY
4. EMPLOYMENT
A. USUAL OCCUPATION Dispatcher
B. TYPE OF INDUeJRY OR, ~USINESS I ranscare
5. PLACE OF BIRTH I-'OugnKeepsle, NY
(CITY, STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME Francis Leonard Ludwig Sr.
B. COUNTRY OF BIRTH U ::; A
7, MOTHER AI' . A A d
A. MAIDEN NAME ICla nn n erson
B. COUNTRY OF BIRTH U::; A
1
8, NUMBER OF THIS MAR81AGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV~CE CIVIL A~ULMENT
B. BIRTH NAME (MAIDEN NAME), L DlaERENT
C. SURNAME AFTER MARRIAGE U wig
(OPTIONAL - SEE REVERSE>12 7 - f 4-9//1
D. SOCIAL SW NUMBER uutchess
12. RESIDENCE A. B.
(STATE) ~ (COUNTY)
C. CHECK ~ .0 CITY ' TOWN 0 VILLAGE
AND l"'ougnKeep e
SPECIFY 199 eower Rd 1260~
D. STREET ADDRESS ZIP
.,
E. IS RE~!CE WITHIN UMITS OF CITY OR INCORPORATi'bVlllAGE? ?6 0 YE~ M ~O
13. A. AGE 3B. DATE OF BIRTH L. ~
MONTH DAY YEAR
14. EMPLOYMENT M d' I A 't t
e Ica SSIS an
A, USUAL OCCUPATION Medical.
B. TYPE OF IND~TRY Oih~SINESS, N' ,
15. PLACE OF BIRTH oug eepsle, y
(CITY, STATE / COUNTRY IF NOT USA)
16. FATHER David Gerard Kovar
A, NAME USA
B. COUNTRY OF BIRTH
17. MOTHER '
Dora Lynn Hollister
A. MAIDEN NAME USA
B. COUNTRY OF BIRTH I
18. NUMBER OF THIS MARRIAGE
12569
.,
Y/ ~9"9
YEAR
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DI60RCE CIVIL A~ULMENT
D'tlTH
D~TH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
(3) 0 ANNULMENT (2) 0 DEATH
/ /
,.~ YEAR
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY. YEAR) (CITYICOUNTY, STATEICOUNTRY, IF NOT USA) SELF SPOUSE
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE?, 0 YES 0 NO
I ..
20. IF PREVIOUSLY DIVORCED OR ANNULLED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY/COUNTY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
YEAR
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER,
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED,
STATE
27. TYPE OF CEREMONY
o 0 RELIGIOUS
9 0 OTHER, SPECIFY
A. STATE NEW YORK B. COUNTY D 1/ 17 IJI'~
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF P"fOWN OF 0 VILLAGE OF
SPECIFY j+;Jf:,Uf(t:;d.v~
28. PLACE WHERE MARRIAGE OCCURRED
l~IL
NAME (PRINT)
SIGNATURE~
NAME (PRINT)
SIGNATURE~