Spouse One First Name Middle Name Last Name Suffix (Jr, Sr, III,etc) Birthplace (US State or Foreign Country) Sex Male Female X Date of Birth (Month, Day, Year) Phone Number Education - Specify Highest Grade Completed 12th Grade or less, no Diploma High School Graduate/GED Completed Associates Bachelors Masters Doctorate or Professional degree Residence (No. And Street) City or Town County US State (Or Foreign Country) ALABAMA ALASKA AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FEDERATED STATES OF MICRONESIA FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARSHALL ISLANDS MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA NORTHERN MARIANA ISLANDS OHIO OKLAHOMA OREGON PALAU PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Supervision or Control by Guardian or Conservator Yes No # of this Marriage/Civil Union 1 2 3 4 5 6 7 8 9 10 Last Relationship (Marriage/Civil Union) Ended By Annulment Death Dissolution Marrying CU Partner Father\Parent Name (FIRST, MIDDLE, LAST NAME(s) PRIOR TO 1ST MARRIAGE, Suffix (ex. Jr., Sr., II, III, etc.)) Father\Parent Birthplace (US State or Foreign Country) Mother\Parent Name (FIRST, MIDDLE, LAST NAME(s) PRIOR TO 1ST MARRIAGE, Suffix (ex. Jr., Sr., II, III, etc.)) Mother\Parent Birthplace (US State or Foreign Country) Spouse Two First Name Middle Name Last Name Suffix (Jr, Sr, III,etc) Birthplace (US State or Foreign Country) Sex Male Female X Date of Birth (Month, Day, Year) Phone Number Education - Specify Highest Grade Completed 12th Grade or less, no Diploma High School Graduate/GED Completed Associates Bachelors Masters Doctorate or Professional degree Residence (No. And Street) City or Town County US State (Or Foreign Country) ALABAMA ALASKA AMERICAN SAMOA ARIZONA ARKANSAS CALIFORNIA COLORADO CONNECTICUT DELAWARE DISTRICT OF COLUMBIA FEDERATED STATES OF MICRONESIA FLORIDA GEORGIA GUAM HAWAII IDAHO ILLINOIS INDIANA IOWA KANSAS KENTUCKY LOUISIANA MAINE MARSHALL ISLANDS MARYLAND MASSACHUSETTS MICHIGAN MINNESOTA MISSISSIPPI MISSOURI MONTANA NEBRASKA NEVADA NEW HAMPSHIRE NEW JERSEY NEW MEXICO NEW YORK NORTH CAROLINA NORTH DAKOTA NORTHERN MARIANA ISLANDS OHIO OKLAHOMA OREGON PALAU PENNSYLVANIA PUERTO RICO RHODE ISLAND SOUTH CAROLINA SOUTH DAKOTA TENNESSEE TEXAS UTAH VERMONT VIRGIN ISLANDS VIRGINIA WASHINGTON WEST VIRGINIA WISCONSIN WYOMING Supervision or Control by Guardian or Conservator Yes No # of this Marriage/Civil Union 1 2 3 4 5 6 7 8 9 10 Last Relationship (Marriage/Civil Union) Ended By Annulment Death Dissolution Marrying CU Partner Father\Parent Name (FIRST, MIDDLE, LAST NAME(s) PRIOR TO 1ST MARRIAGE, Suffix (ex. Jr., Sr., II, III, etc.)) Father\Parent Birthplace (US State or Foreign Country) Mother\Parent Name (FIRST, MIDDLE, LAST NAME(s) PRIOR TO 1ST MARRIAGE, Suffix (ex. Jr., Sr., II, III, etc.)) Mother\Parent Birthplace (US State or Foreign Country) Refresh
