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Provide the requested details in the The statistical information below, Telephone Number:, y n O s e s o p r u P, a c, i t s, i t a t S r o F, D E R U Q E R S, T U B, Groom Information, Bride Information, Race, Social Security Number**, Race, Social Security Number**, ☐ Black ☐ White ☐ Other, ☐ Black ☐ White ☐ Other, Number of this Marriage, Date Last Marriage Ended, Number of this Marriage, Date Last Marriage Ended, MM DD YYYY, MM DD YYYY, How Did Last Marriage End, How Did Last Marriage End, ☐ Divorce ☐ Death ☐ Annulment, ☐ Divorce ☐ Death ☐ Annulment, **Pursuant to the federal Personal, Disclosure of social security, Family Law Statement, or or, _____ have _____ separately, and _____ have not _____ together part.

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