| Church/Organization | – Attending Iglesia Cristiana Sanidad Divina |
| Preferred First Name | |
| Street Address | 15985 Cascade Path |
| City | Rosemount |
| Postal/Zip Code | 55068 |
| Mobile Phone | |
| Home Phone | |
| Office Phone |
| Membership Credential | |
| Marital Status | Married |
| Length of Marriage | 31 years, 4 months ago |
