| Church/Organization | |
| Preferred First Name | |
| Street Address | 9672 Norfolk Ave |
| City | Laurel |
| Postal/Zip Code | 20723 |
| Mobile Phone | |
| Office Phone |
| Membership Credential | |
| Mailing List | No |
| Marital Status | Widow |
| Length of Marriage | 2 years, 4 months ago |
