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(1m'" "''''''''"'10 rUH I:;/A/e USE ONL Y)
'-'.... Lvi n::;~\:l
COUNTY
Wappinger
CITYfTOW}J
DISTRICT 1 368 '
NUMBER
REGISTER 66
NUMBER
~. .w_.. .............. ..,
-O"EPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
1 . A. FUll NAME
FROM THE GROOM
Kevin Jeffrey Brown
MIDDLE CURRENT SURNAME
1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
4TH , 0 0 4TH 0 0
I duly swear/affirm, depose and say, that to the be t of my knowledge and belief that the information I provided is true and that I declare that no legal impediment exists
as to my right to enter into the m nag~state, ,
21.SIGNATUREOFGROOM~ 2.SIGNATUREOFBRIDE~ Go1i'llQArJ ~~
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ~:E CU r USE CURRENT NAME 07/06/2009
SIGNATURE OF TOWN OR CITY CLERK ~ DATE
This license authorizes the marriage in New York State of the bride and groom named above by any person authorized by New York Domestic
Relations Law ~11 to perlorm 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 CI~ ER 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
07/06/2009 TIME MONTH YEAR MONTH
SEAL SIGNATURE ~ DATE
MA~~ ,NY 12590 AM 07 07 2009 09 04 2009
'-v-1 03:38pM
ZIP
FIRST
ll.
N
B. BIRTH NAME. IF DIFFERENT
C SURNAME AFTER MARRIAGE
. (OPTIONAL. SEE REVERSE>203_68_6011
D SOCIAL SECURITY NUMBER Dutchess
2. RESIDENCE A. NY B. (COUNTY)
(STATE) M
C. CHECK ONL Q. CITy, TOWN 0 VILLAGE
AND t:.ast t-ISnKI
SPECIFY ( t:;uroaK Ur,
D. STREET ADDRESS ZIP
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED OI3LAGE/ 3.p
3. A. AGE 22 3B. DATE OF BIRTH MONTH DAY
4. EMPLOYMENT M' T her
USIC eac
A. USUAL OCCUPATION education
R TYPE OF INDUSTRY 01;1 RIICI"~OO .
' 'tc:rTY. STATE / COUNTRY IF NOT USA)
5. .F.'lM~"
A. NAME Jeffrey James Brown
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Debra Beth Ritenbaugh
B. COUNTRY OF BIRTH USA
1
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV5RCE CIVIL ANaULMENT
D~TH
12533
01
YES (] NO
/1987
YEAR
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
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) (CITY/COUNTY. STATE/COUNTRY. IF NOT USA) SELF SPOUSE
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 ~ RELIGIOUS
9 0 OTHER, SPECIFY
DATE
,/'J1
STATE
SIGNATURE~
DOH-9B (0312006)
Lo
SUPPLEMENTAL FILE
FROM THE BRIOE ..
Gretchen Sarah Meibauer
CURRENT SURNAME
11. A. FULL NAME
FIRST
MIDDLE
B BIRTH NAME (MAIDEN NAME). IF DIFFERENT
. Brown
c. sV~~~~Mrr~~~t~~b~~SE14 7 -82 -83 7 4
D. SOCIALSmTYNUMBER Uutchess
12. RESIDENCE A. (STATE) oL B. (COUNTY)
C CHECK D.N.I'I 0 CITY 0 TOWN 0 VILLAGE
. AND vvapplnger
SPECIFY 17 Ervin Dr. ZIP 12590
D. STREET ADDRESS .,
E. IS RE2DiNCE WITHIN LIMITS OF CITY OR INCORPORA1J~VILLAGE)2 0 Yj9810
13. A. AGE 3B. DATE OF BIRTH MONTH DAY YEAR
14. EMPLOYMENT Sales
A. USUAL OCCUPATION RetaIl
R TV!)" ('\t: 1""'~"8'/)1:la'n~"NJ
15. PLACE OF BIRTH '
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER W'II' H M 'b
NAME I lam , el auer
,A. , l.J SA
B. COUNTRY OF BIRTH
17. MOTHER R th C I R'
u aro Igney
A. MAIDEN NAME USA
B. COUNTRY OF BIRTH 1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
D~ORCE CIVIL A~ULMENT
DttTH
B. HOW DID LAST MARRIAGE END?
(3) 0 DIVORCE
(3) 0 ANNULMENT (2) 0 DEATH
/ /
. - YEAR
C. DATE LAST MARRIAGE ENDED?
MONTH DAY
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
..
20. IF PREVIOUSLY DIVORCED OR ANNULLED. PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH. DAY. YEAR) (CITY/COUNTY, STATE/COUNTRY. IF NOT USA) SELF SPOUSE
YEAR
10 CIVIL
2B. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY b ttlu(
NAME (PRINT)
SIGNATURE~