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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
David Thomas Ludwig
FIRST MIDDLE
23. SUBSCRIBED AND SWORN TO BEFORE ME
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 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 "L~Rf:. M. t. . 25. A. SOLEMNIZATION PERIOD BEGINS
} NAME (PRINT) .Jon~b gS. ~rSon
{~ . ~~~~~~PJM~aUs. NY" ~~~~0D5 3:::' AM ~'" 24 2~; ~:"" 22';00:'"
STREET CITYITOWN STATE ZIP PM
I CERTIFY THAT I SOLEMNIZED 26. SOLEMNIZATION OCCURRED 27~TYPOF CEREMONY
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE TIME MO. DAY YEAR 0 RELIGIOUS 1 0 CIVIL
DATE AND AT THE TIME AND ~
PLACE INDICATED 3:.t'O ~W /1 oS- 90 OTHER, SPECIFY
29 OFFICIANT /l1SG-~. '1c IJ../ljr-:S ?
NAME (PRINT) r("", \4
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COUNTY Dutchess
CITYfTOW1J wappinger
DISTRICT 1 368
NUMBER
REGISTER 143
NUMBER
1. A. FULL NAME
CURRENT SURNAME
Il.
N
B BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)079-60-8296
D SOCIAL SECURITY NUMBER
2. RESIDENCE A New York B. Dutchess
(STATE) <V' (COUNTY)
C. CHECK ON~.. Q CITY 0 TOWN 0 VILLAGE
~~~CIFY wappinger
D. STREET ADDRESS '1668 Route 9 una J P ZIP 12~!:IU
"
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES 0 NO
3. A. AGE 43 38. DATE OF BIRTH 08 /31 /1962
MONTH DAY YEAR
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4. EMPLOYMENT
A USUAL OCCUPATION Unemployed
B. TYPE OF INOUERY QIJ.flUSJNESS
5. PLACE OF BIRTH 010 ~pnng, New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A NAME Leo Edward Ludwig, Sr.
8. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Maryann Koteny
8. COUNTRY OF BIRTH U S1 A
B. NUMBER OF THIS MARRIAGE
9. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIV'{fCE CIVIL A~ULMENT
D~TH
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8. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT
C DATE LAST MARRIAGE ENDED? / /
(2) 0 DEATH
MONTH DAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED . AGAINST WHOM
(MONTH. DAY. YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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21. SIGNATURE OF GROOM
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TITLE
NAME (PRINT)
SIGNATURE ~
DOH-9B (11/98)
I
STATt:. t-ILt:. NUMDl::n
(THIS SPACE FOR STATE USE ONLY)
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
11. A. FULL NAME Marguerite Malone
FIRST MIDDLE
CURRENT SURNAME
B. BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Malone - Ludwig
(OPTIONAL. SEE REVERSE) 150-54-3532
D. SOCIAL SECURITY NUMBER
12 RESIDENCE ANew York B Dutchess
(STATE) J (COUNTY)
C. CHECK ONE CJ CITY 0 TOWN 0 VILLAGE
~~~CIFY Wappinger
D. STREET ADDRESS 166H Koute 9 Unit 3 P
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE43 13.B. DATE OF BIRTH 06 )S
ZIP 1259U
~
o YES 0 NO
1962
YEAR
MONTH
DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Cashier
8. TYPE OF INOU~TRY OR B~INESS supermarket
15. PLACE OF BIRTH Jersey L;:ity, New Jersey
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Gerald Brenden Malone
8. COUNTRY OF BIRTHU 5 A
17. MOTHER
A. MAIDEN NAME Janet Ackerman
B. COUNTRY OF BIRT~ S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIOORCE CIVIL A~ULMENT
DEATH
o
8. 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
20. IF PREVIOUSLY DIVORCED OR ANNULEO, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
1ST
2ND
3RD
4TH
that th~ information I provided is tru
o 0
o 0
o 0
o 0
I impediment exists
25. B. SOLEMNIZATION PERIOD
ENDS AT MIDNIGHT ON:
28. PLACE WHERE MARRIAGE OCCUR~
A. STATE NEW YORK B. COUN~rc:;~
/2, c. rK/PsY
/1 /:2. 7~!.-
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ZIP
31. WITNESS TO CEREj'AONY
NAME (PRINT) 1-
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY) .
o CITY OF 0 TOWN OF ~AGE OF
SPECIFY ~Vmt"(tV6F~.s F~
SIGNATURE ~