(Your full given names) ,

(Check one) son or daughter of  (Father's full name)  and

(Mother's full name plus her maiden name)

you were born on (day/mo./yr) in the city of .

(Spouse's Name)

(Check one) son or daughter of   (Father's full name)  and

(Mother's full name)

your spouse was born on (day/mo./yr) in the city of .

You were married on (day/mo./yr) in the (Name of Church)

at (Name of City) .

Do you have children  (check one) yes no

(1st Child's full name) (Child's birthdate) (day/mo./yr)
(Child's place of birth)

(2nd Child's full name) (Child's birthdate) (day/mo./yr)
(Child's place of birth)

(3rd Child's full name) (Child's birthdate) (day/mo./yr)
(Child's place of birth)

(Nickname you go by)

You are employed as (Occupation title)

Please state any hobbies or special interests

Health Challenges (for genetic links to other relatives)  

(Nickname your spouse goes by)

(Occupation title)  

Please state any hobbies or special interests

Health Challenges (for genetic links to other relatives)