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N
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Nathan Checklev Kropf
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYrrOWN Wappinger
~~~:~: 1368 .
~G~I~J~R 158
1. A. FUll NAME
FIRST
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE) 131-70-2464
D. SOCIAL SECURITY NUMBER
2, RESIDENCEA. New York B. Ulster
(STATIj,) (COUNTY)
C, CHECK ONE I!! CITY 0 TOWN 0 VILLAGE
~~~CIFY Kingston
D, STREET ADDRESS 300 Greenkill Avenue ZIP 12401
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? dYES 0 NO
3. A AGE 22 38. DATE OF BIRTH 08 / 19 / 198
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION Service Technician
8. TYPE OF INDUSTRY OR BUSINESS Sign Company
5. PLACE OF BIRTH Kingston, New York
(CITY, STATE I COUNTRY IF NOT USA)
6. FATHER
to-
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II(
A. NAME Robert Brett Kropf
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Angela Marie Checkley
B. COUNTRY OF BIRTH U S A
1
8. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVOBCE CIVIL ANN~LMENT
DEAOH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT "......(,2,)D".,D,E,A TH
7 7 .... .
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
I
STATE FILE NUMBER
(THIS SPACE FOR STATE USE ONL Y)
I
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Megan Elizabeth Dawson
MIDDLE CURRENT SURNAME
-.J
11. A, FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C. SURNAME AFTER MARRIAGE Kropf
(OPTIONAL - SEE REVERSE) 099-76-5059
D. SOCIAL SECURITY NUMBER
12. RESIDENCE A. New York B Dutchess
(STATE)..J (COUNTY)
C. CHECK ONE 0 CITY U TOWN 0 VILLAGE
AND W .
SPECIFY applnger
D, STREET ADDRESS 9 Orange Court
1259U
ZIP
E, IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 6 NO
11 / 17 /1984
DAY YEAR
13. A, AGE 21
3B. DATE OF BIRTH
MONTH
14. EMPLOYMENT
A. USUAL OCCUPATION Clerical
B. TYPE OF INDUSTRY OR BUSINESS Suny New Paltz
15. PLACE OF BIRTH Beaver, Rennsylvanla
(CITY, STATE I COUNTRY IF NOT USA)
16. FATHER
A. NAME Barry Lawrence Dawson
'B. COUNTRY OF BIRTH USA
17, MOTHER .
A. MAIDEN NAME Susan Elaine Jerrett
B. COUNTRY OF BIRTH USA
1
18. NUMBER OF THIS MARRIAGE
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVBRCE CIVIL AN~LMENT
DEt)"H
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
/ (
MONTH DAY YEAR
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
C. DATE LAST MARRIAGE ENDED?
1ST
2ND
3RD
4TH
I duly swear/affirm, dep.ose and sa
as to my right to enter into the
21, SIGNATURE OF GROOM~
1ST 0 0
2ND 0 0
~ 0 0
4TH 0 0
lief that the information I provided is true and that I declare LJo legal impediment exists
22. SIGNATURE OF ~RIDE~tc.f){.R tJCJN /Q.J.,{) (J/..J!\..J
~RRENT NAME 09/27/2006
DATE
USE C R
23, SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New 'York State of the bride and groom named above by any person authorized
Relations Law ~11 to pertorm 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 ,QLj:;RK C M t 25 A SOLEMNIZATION PERIOD BEGINS
JOnn . as erson .. .
NAME (PRINT)
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{ SEAL }
'-.t-'
by New York Domestic
TIME
MONTH
YEAR
MONTH
YEAR
09/27/200
DATE
appinger Falls, NY 12590
06:2~~
09
28
2006
11
ZIP
ClTYfTOWN
26. SOLEMNIZATION OCCURRED
TIME MO. DAY YEAR
/ f ~M {, 010
(;R t/6S me' Stffl/JIt- PM17:/?.
A-.- DATE 10 ~ b
'Of..{ 9/7 Ir /J" /1S (p IlAJ /;2.60 !J
.., ~ STAFT
STATE
27. TYPE OF CEREMONY
o !Sf RELIGIOUS
9 0 OTHER, SPECIFY
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED,
29. OFFICIANT a
NAME (PRINT) (\ U
SIGNATURE~
DOH-98 (0312006)
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY "7:A.JkttLJ)
c. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~ TOWN OF 0 VILLAGE OF
SPECIFY ':;0 Ll6 HlW (/.5/ {;
10 CIVIL
NAME (PRINT)
SIGNATURE~