| Church/Organization | |
| Preferred First Name | |
| Street Address | 16438 225th Ave |
| City | Bloomer |
| Postal/Zip Code | 54724 |
| Mobile Phone | |
| Home Phone | |
| Office Phone |
| Membership Credential | |
| Mailing List | Yes |
| Marital Status | Remarried |
| Length of Marriage | 41 years, 8 months ago |
