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1. A. FULL NAME
STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
JoseDh Ruaaiero. JR.
. FIRST MIDDLE
CURRENT SURNAME
(THIS SPACE FOR STA TE USE ONL Y)
COUNTY Dutchess
CITYITOWN Wappinger
~m::lf: 1368
~5~~J~R 66
L 0 SUPPLEMENTAL FILE
11. A.
FROM THE BRIDE
FULL NAME Stephanie Anne Bosco
FIRST MIDDLE
CURRENT SURNAME
B. BIRTH NAME, IF DIFFERENT
C. SURNAME AFTER MARRIAGE
(OPTIONAL - SEE REVERSE)050-10-6115
D. SOCIAL SECURITY NUMBER
2. RESIDENCE A. N Y B. Dutchess
(STATE).J (COUNlYl
C. CHECK ONE 0 CITY ~ TOWN 0 VILLAGE
AND W .
SPECIFY apPlnaer
D. STREET ADDRESS 1668 Route 9 Apt. 9 G ZIP 12590
E. IS RESIDENCE WITHIN LiMITS OF CITY OR INCORPORATED VILLAGE? 0 YES ~ NO
11 /23 /1969
MONTH DAY YEAR
3. A. AGE 35
3B. DATE OF BIRTH
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4. EMPLOYMENT
A. USUAL OCCUPATION Supervisor
8. TYPE OF INDUSTRY OR BUSINESS Town Of Wappinger
5. PLACE OF BIRTH Yonkers. New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Joseph Peter Ruggiero
8. COUNTRY OF BIRTH USA
7. MOTHER
A. MAIDEN NAME Carols La Pietro
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
17. MOTHER
A. MAIDEN NAME Rosemary Viccaro
B. COUNTRY OF BIRTH USA
lB. NUMBER OF THIS MARRIAGE 1
19. PREVIOUS MARRIAGES
A. NUMBER OF PREVIOUS MARRIAGES WHICH ENDED BY
DIVORCE CIVIL ANWLMENT DEfiH
B. HOW D1Dl:^ST 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 ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
B. HOW DID LAST MARRIAGE END? (3) 0 DIVDRCE
C. DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) 0 DEATH
MONTH OAY YEAR
D. ARE ANY FORMER SPOUSE(S) ALIVE? 0 YES 0 NO
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOULOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATE/COUNTRY, IF NOT USA) SELF SPOUSE
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1ST 0 0 1ST 0 0
2ND 0 0 2ND 0 0
3RD 0 0 3RD 0 0
~ 0 0 ~ 0 0
I, being duly sworn, depose and say, that to the best/lf m nowledge and belief that the information I provided is true and that I declare that no legal i,mpediment exists
as to my right to' enter into the rriage state.' &a;-..... J _ " ": t.i)
21. SIGNATURE OF GROOM ~ . 22. SIGNATURE OF BRIDE ~ ,J-Hl../'l./lLL. ~
E CURRENT ' USE CURRENT NAME
23. SUBSCRIBED AND SWORN T B FORE ME 01/1512005
SIGNATURE OF TOWN OR C LERK ~ DATE
This license authorizes t 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 CI1 CLERK 25. A. SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT)
011151200 TIME MONTH YEAR MONTH
SEAL SIGNATURE'~ DATE
'-.-' MAI~ fl. gerFaUs, NY 12590 12:4~~ 01
STREET C frOWN ST A E ZIP
~~~R~:R~~~ IO~~~N~Z:~ 26. SOLEMNIZATION OCCURRED 27. TYPE OF CEREMONY
SONS NAMED ABOVE ON THE TIME M. DAY YEAR 0 0 RELIGIOUS -JJI CIVIL
~~~E ~glt;TJ~E TIME AND AM 9 0 OTHER, SPECIFY
YEAR
13 2005
16
2005
09
28. PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B. COUNTY P 'f1tr:sS
C. LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
29. OFFICIANT
NAME (PRINT)
-
l.;.l f f Co
ZIP
31. WITNESS TO CEREMON^^ . . l
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SIGNATURE~ - .~ --y~~