063
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
P:::llli r.hri~ti:::ln Fm:::lnllp.1 M:::lrin:::lr.r.in
FiRsT MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITYrrOWN Wappinger
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1 . A. FULL NAME
B. BIRTH NAME. IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)
D SOCIAL SECURITY NUMBER 070-74-3767
2 RESIDENCE A. NY B nlltr.hp.~~
(STATE) (COUNTY)
C CHECK ONE 0 CITY olJ TOWN 0 VILLAGE
AND W .
SPECIFY ;:Jppmger
D STREET ADDRESS 235 Cedar Hill Road ZIP 12590
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES..o NO
3. A. AGE 25 36. DATE OF BIRTH OR / 1? /1 qR?
MONTH DAY YEAR
4. EMPLOYMENT
A. USUAL OCCUPATION l:::lhnrp.r
B. TYPE OF INDUSTRY OR BUSINESS Construction
5. PLACE OF BIRTH Rp.acnn NY
(CITY. STATE / COUNTRY IF NOT USA)
6. FATHER
A. NAME R:::llrh M:::lrin:::lr.r.in. .Ir
B. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Nancy Joan Ziegler
B. COUNTRY OF BIRTH USA
8. NUMBER OF THIS MARRIAGE 1
9. PREVIOUS MARRIAGES -
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
(2) 0 DEATH
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
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
Nicole M;:Jrie Celentano
MIDDLE CURRENT SURNAME
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11. A. FULL NAME
FIRST
B. BIRTH NAME (MAIDEN NAME). IF DIFFERENT
C SURNAME AFTER MARRIAGE M:::lrin:::lcdn
(OPTIONAL - SEE REVERSEb
o SOCIAL SECURITY NUMBER 76-70-4263
12. RESIDENCE ANY BDutchess
(STATE) (COUNTY)
C. CHECK ONE 0 CITY olJ TOWN 0 VILLAGE
~~~CIFYEast Fishkill
D. STREET ADORES;;?} Clearview Circle
ZIP 12533
o YES'tJ NO
;(985
YEAR
E. IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE?
13. A. AGE2? 3B. DATE OF BIRTH OR ,,15
MONTH DAY
14. EMPLOYMENT
A. USUAL OCCUPATION Teacher
6. TYPE OF INDUSTRY OR BUSINESS Wappinaer CSD
15. PLACE OF BIRTHMount Kisco. NY
(CITY. STATE / COUNTRY IF NOT USA)
16. FATHER
A. NAME Dennis .James Celentano
. B. COUNTRY OF BIRTJ.! S A
17. MOTHER
A. MAIDEN NAME Cheryl Lynn Nast
B. COUNTRY OF BIRTJ.! S A
18. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANNULMENT
o 0
DEATH
o
B. HOW DID LAST MARRIAGE END? (3) 0 DIVORCE (3) 0 ANNULMENT (2) 0 DEATH
C. DATE LAST MARRIAGE ENDED? / (.
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
o
o
o
1ST
2ND
3RD
o 0
o 0
o 0
o 0
'mpediment exists
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1ST
2ND
3RD
4TH
I duly swear/affirm, depose and
as to my right to enter into the
21. SIGNATURE OF GROOM~
USE
23. SUBSCRIBED AND SWORN TO/AFFIRMED BEFORE ME
SIGNATURE OF TOWN OR CITY CLERK ~
This license authorizes the marriage in New ork State of the 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
NAME (PRINT) h C. Masterson
~
{ SEAL}
'-..-'
06/06/200
DATE
by New York Domestic
TIME
MONTH
YEAR
MONTH
YEAR
SIGNATURE ~
MAILING ADORE
20 Middl
STREET
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER-
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED.
DATE 06/06/2008
ap~tt'~;Js Falls.s~,:r 1259qlP
26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
TIME MO. DAY YEAR 0 0 RELIGIOUS 1 ~~IL
~ 9 0 OTHER. SPECIFY
Q
~
NAME (PRINT)
SIGNATURE~ .
AM
03:40 PM 06
08
05 2008
07
2008
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUN~CJ~
C. LOCATION OF CEREMONY
(CHECK ONE AND S IFY)
f~
31.
NAME (PRINT)
SIGNATURE~