| Church/Organization | |
| Preferred First Name | |
| Street Address | Po Box 1093 |
| City | Duarte |
| Postal/Zip Code | 91009 |
| Mobile Phone | |
| Website | |
| Home Phone |
| Membership Credential | |
| Marital Status | Married |
| Length of Marriage | 4 years, 10 months ago |
