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STATE OF NEW YORK
DEPARTMENT OF HEALTH
AFFIDAVIT, LICENSE and
CERTIFICATE OF
MARRIAGE
FROM THE GROOM
Glen Castelli
MIDDLE CURRENT SURNAME
COUNTY Dutchess
CITY/TOWN Wappinger
~~~~k~T 1368
~~~I~J~R 64
A. FULL NAME
FIRST
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B BIRTH NAME. I F DIFFERENT
C SURNAME AFTER MARRIAGE
(OPTIONAL. SEE REVERSEb51 72 2653
o SOCIAL SECURITY NUMBER --
2 RESIDENCE A. N Y B Dutchess
(STATE) (COUNTY)
C CHECK ONE 0 CITY '6 TOWN 0 VILLAGE
~~~CIFY Beekman
o STREET ADDRESS 166 Stagecoach Pass ZIP 12582
E IS RESIDENCE WITHiN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES'6 NO
03 /28 / 1971
MONTH DAY YEAR
3 A AGE~1
3B. DATE OF BIRTH
4 EMPLOYMENT
A USUAL OCCUPATION Bodv Shop
B. TYPE OF INDUSTRY OR BUSINESS Own Business
5 PLACE OF BIRTH Carmel, New York
(CITY, STATE/COUNTRY IF NOT USA)
6. FATHER
A. NAME Frank Castelli
B COUNTRY OF BIRTH USA
7. MOTHER
A MAIDEN NAME Sheila Wood
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
B 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
10. IF PREVIOUSLY DIVORCED OR ANNULED, PROVIDE THE FOLLOWING INFORMATION
DATE OF DECREE PLACE ISSUED AGAINST WHOM
(MONTH, DAY, YEAR) (CITY, STATElCOUNTRY, IF NOT USA) SELF SPOUSE
I
STATE FILE NUMBER
(THIS SPACE FOR STA TE USE ONL Y)
I
{}ill
~-JI'&?~
L 0 SUPPLEMENTAL FILE
FROM THE BRIDE
Dena M. Ruggiero
MIDDLE CURRENT SURNAME
~
11. A FULL NAME
FIRST
B BIRTH NAME (MAIDEN NAME), IF DIFFERENT
C SURNAME AFTER MARRIAGE Castelli
(OPTIONAL. SEE REVERSE)098_62_2749
o SOCIAL SECURITY NUMBER
12 RESIDENCE ANY B. Dutchess
C CHECK ONE (STA~) CITY ~ TOWN 0 VILLAGE (COUNTY)
~~~CIFY Beekman
o STREET ADDRESS 166 Stagecoach Pass ZIP 12582
E IS RESIDENCE WITHIN LIMITS OF CITY OR INCORPORATED VILLAGE? 0 YES r:i NO
00 /22 ~97ro
13 A AGE23
13.B. DATE OF BIRTH
MONTH
DAY
YEAR
14, EMPLOYMENT
A. USUAL OCCUPATION Tax Consultant
B. TYPE OF INDUSTRY OR BUSINESS Ernst & Young
15 PLACE OF BIRTH Mt. Kisco, New York
(CITY, STATE/COUNTRY IF NOT USA)
16. FATHER
A. NAME Thomas Rum-liero
B COUNTRY OF BIRTHU S A
17. MOTHER
A. MAIDEN NAME Christina Mason
B COUNTRY OF BIRTHU 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
C, DATE LAST MARRIAGE ENDED?
(3) 0 ANNULMENT
/ /
(2) D DEATH
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
ffi
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o 0 1ST 0 0
o 0 2ND 0 0
o 0 3RD 0 0
o 0 4TH 0 0
st of my knowledge and belief that the Information 1 provided IS true ,":1 declare that no legal Impediment eXists
\ 22 SIGNATURE OF BRIDE ~ ~~dz{;qQ Q:!~ 0
USE CU ENT NA E USE CURRENT Nt!::l'" ~
DATE OS/21/2002
3RD
4TH
I, being duly sworn, depose and say, llJat to the
as to my right to enter into the m~Kiag' ate.
21 SIGNATURE OF GROOM ~.
/
23 SUBSCRIBED AND SWORN TO FORE 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 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 CL~RK 25. A, SOLEMNIZATION PERIOD BEGINS
{ } NAME (PRINT) ~~~r:la::. .~O~Sle MONTH
SEAL SIGNATURE ~/' . ~ I,
'-y-I M~t~~~8~~ ush Rd>Wa 05
STREET /
I CERTIFY THAT I SOLEMNIZED
THE MARRIAGE OF THE PER.
SONS NAMED ABOVE ON THE
DATE AND AT THE TIME AND
PLACE INDICATED
1ST
2ND
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by New York Domestic
ZIP
YEAR
1 [j CIVIL
2B PLACE WHERE MARRIAGE OCCURRED
A. STATE NEW YORK B COUNTY w,Jfc~'.rI
TITLE R. C. 1'/,,'(' r f-
DATE 6/r/O::2.
M, tfr NT /O,J"<;!
C LOCATION OF CEREMONY
(CHECK ONE AND SPECIFY)
o CITY OF ~TOWN OF 0 VILLAGE OF
SPECIFY YO f' k -/-6....~
I
STATE