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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDA VIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Chris_l:!cr MichQQ(\~~HraRNAME
21. SIGNATURE OF GROOM"
23. SUBSCRIBED AND SWORN TO/AFFIRMED B
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New ork State of e bride and groom named above by any person authorized
Relations Law ~11 to perform 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 CITY CLERK 25.'A. SOLEMNIZATION PERIOD BEGINS
COUNTY Dutchess
CITYfTOWN \^'appinger
DISTRICT . .
~~~I~~~R1368
NUMBER 1 '1 9
1. A. FULL NAME
FIRST
ll.
N
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 098 68 3316
2. RESIDENCEA. ~Al\ B. r.A;,.j.....I~ocv
1\I1/(9TATE) "'t~NWj' "
C. ~~5CK ONE 0 CITY ~ TOWN 0 VILLAGE
SPECIFY Stoneh3m
D STREET ADDRESS 12 Hillside Ro.d; A.pt 101 ZIP 02180
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES olJ NO
3. A. AGE 36 3B. DATE OF BIRTH M~ / Q~ / ~~72
4. EMPLOYMENT
A, USUAL OCCUPATION Computer Programmer
B. TYPE OF INDUSTRY OR BUSINESS Financial
5. PLACE OF BIRTH F.l:4:l~d. Mv
lcl"., "S"1l(~ ~ t;o~N'r1lY IF NOT USA)
6, FATHER
A. NAME ^rthur Jiran
B. COUNTRY OF BIRTH IJ S A
7. MOTHER
A. MAIDEN NAME Nancy Kappler
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 2
9, PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
1
o
B, HOW DID LAST MARRIAGE END? (3) iiil' DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C, DATE LAST MARRIAGE ENDED? 03 / ~ 1 / ')n04
MONTH D)!'f ~
D, ARE ANY FORMER SPOUSE(S) ALIVE? ~ES 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
1ST 03/31/2004 Providence, Rhode Island
2ND
3RD
4TH
I duly swear/affirm, depose and sa
as to my right to enter into the m
W
en
z
W
()
::i
~
{ SEAL }
'-v-I
o
~i1 A Tt: ~ILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Kr~EMarie N~JRRENTSURNAME
~
11, A. FULL NAME
FIRST
8. 81RTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE lir3n
(OPTIONAL - SEE REVER~T
D. SOCIAL SECURITY NUM8ER 091-64-0638
12. RESIDENCE A'M,A/STATE) 8, M i~ex
c. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND
SPECIFY Stoneham
o STREET ADDREss1? Hillsirlp Rn::lrl: Art 101 z1P0?1 RO
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
t~NTH -1)~AY ,{ ~Z~
13, A. AGE 33
14, EMPLOYMENT
A. USUAL OCCUPATION PrO;ject Specialist
B. TYPE OF INDUSTRY OR BUSINESS Health G::lre
15, PLACE OF BIRTH ~cffi:l~h~~~t?m-%~)F'Nt'!~SA)
16. FATHER
3B. DATE OF BIRTH
A. NAME.A.lois joh.nn Neff
'B. COUNTRY OF BIRTl-Switzerl<;lnrl
17. MOTHER
A. MAIDEN NAME Linda Elizabetr Pohl
B. COUNTRY OF BIRTHI I S A
18, NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
DEATH
o
o
o
(3) 0 ANNULMENT (2) 0 DEATH
/ /
- YEAR
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
~
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
o 1ST
o 2ND
o 3RD
4TH
Ie that the information I pravi
DATE
by New York Domestic
TIME
25. B. SOLEMNIZATION PERIOD
ENOS AT MIONIGHT ON:
AM
02:11 PM 09
30
2008
11
28 2008
I
26. SOLEMNIZATION OCCURRED
TIME MO, DAY YEAR oXJ RELIGIOUS
11L30~ 11-1-08 900THER,SPECIFY
29 OFFICIANT Daniel B. Ward
NAME (PRINT~.
SIGNATURE i/?~~~
MAILING AD
St. John's Lutheran Church 55WilbupsBivd;YPok, NY
STREET CITYfTOWN STATE
30. WITNESS TO CEREMONY
NAME (PRINT) J a e s
NAME (PRINT)
STR
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
TITLE
DATE
DAY
YEAR
MONTH
YEAR
MONTH
09/29/2008
ZIP
10 CIVIL
28. PLACE WHERE MARRIAGE OCCURRED
A, STATE NEW YORK B. COUNTY Dutchess
c, LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
ex CITY OF 0 TOWN OF 0 VILLAGE OF
Pastor
11-1-08
SPECIFY Poughkeepsie
12603
ZIP
31, WITNESS TO CEREMONY
NAME (PRINT) Tammy N e f f
SIGNATURE~