| Preferred First Name | |
| Street Address | 1020 Lakeside Dr |
| City | Gaylord |
| Postal/Zip Code | 55334 |
| Mobile Phone |
| Membership Credential | |
| Mailing List | Yes |
| Marital Status | Married |
| Length of Marriage | 54 years ago |
| Endorsement | ELE |
| Chaplain Status | |
| Place of Chaplaincy | Hospice |
