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PREV. MARRIAGES/SRDP 5B. DATE ENDED 5A. LAST MARRIAGE/SRDP ENDED BY DEATH DISSO ANNULMENT N/A MM/DD/CCYY TERM SRDP 6. ADDRESS 7. CITY 9. ZIP CODE 10A. MAILING ADDRESS IF DIFFERENT 10B. CITY 10C. STATE 10D. ZIP CODE 11A. CITY 22B. CITY 22C. STATE Groom Bride SECOND PERSON DATA FIRST PERSON DATA 23. DATE OF OF MA 2 25. FULL BIRTH NAME OF FATHER/PARENT 11B. STATE OF BIRTH IF OUTSIDE U.S. ENTER COUNTRY 14. DATE OF BIRTH MM/DD/CCYY N/A 19. DATE OF MARRIAGE MM/DD/CCYY FACTS 26. CITY/TOWN OF...
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