| Church/Organization | |
| Preferred First Name | |
| Street Address | Po Box 159 |
| City | Bluewater |
| Postal/Zip Code | 87005 |
| Home Phone | |
| Office Phone |
| Membership Credential | |
| Mailing List | Yes |
| Marital Status | Remarried |
| Length of Marriage | 36 years, 1 month ago |
