Number (leave blank if unknown or none has been assigned)

1. Full Birth Name

2. Place of Birth

3. Date of Birth

4. Schooling, Training

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5. Occupation, Military Service and Organizations

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6. Address

7. Previous Residence (or residences)

8. Death Date

9. Burial Place

10. Full Birth Name of Spouse

11. Birthplace of Spouse

12. Birthdate of Spouse

13. Spouse's Occupation

14. Marriage Date

15. Spouse's Mother's Birth Name before Marriage

Birth Names, Birthdates and Exact Mailing Address (or Date of Death & Place Buried)

16. Children

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17. Brother or Sister

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18. Father

19. Mother

20. Father's Father

21. Father's Mother

22. Mother's Father

23. Mother's Mother