| Church/Organization | |
| Preferred First Name | |
| Street Address | 3639 Snelling Ave |
| City | Minneapolis |
| Postal/Zip Code | 55406 |
| Home Phone | |
| Office Phone |
| Membership Credential | |
| Mailing List | Yes |
| Marital Status | Remarried |
| Length of Marriage | 10 years, 2 months ago |
