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Spouse 1

First Name (Nombre Primero)	Middle Name (Segundo)
Last Name (Appelido)	Suffix (Sufijo)
Maiden/Given Name (Appelido de soltera)
Race (Race)	SSN (Seguro Social)
--Select One-- AFRICAN AMERICAN ALASKAN NATIVE AMERICAN INDIAN ASIAN CAUCASIAN HISPANIC MIDDLE EASTERN OTHER PACIFIC ISLANDER
Street Address (Direccion)	City (Ciudad)
State (Estado o Pais)	Zip Code (Codigo Postal)
AFGHANISTAN (AFG) AGUASCALIENTES (AG-MX) ALABAMA (AL) ALASKA (AK) ALBANIA (ALB) ALBERTA (AB-CAN) ALGERIA (DZA) AMERICAN SAMOA (AS) ANDORRA (AND) ANGOLA (AGO) ANGUILLA (AIA) ANTARCTICA (ATA) ANTIGUA AND BARBUDA (ATG) ARGENTINA (ARG) ARIZONA (AZ) ARKANSAS (AR) ARMED FORCES AFRICA (AE-AFR) ARMED FORCES AMERICAS (AA) ARMED FORCES CANADA (AE-CAN) ARMED FORCES EUROPE (AE-EUR) ARMED FORCES MIDDLE EAST (AE-ME) ARMED FORCES OTHERS (AE-OTHER) ARMED FORCES PACIFIC (AP) ARMENIA (ARM) ARUBA (ABW) AUSTRALIA (AUS) AUSTRIA (AUT) AZERBAIJAN (AZE) BAHAMAS (BHS) BAHRAIN (BHR) BAJA CALIFORNIA (BN-MX) BAJA CALIFORNIA SUR (BS-MX) BANGLADESH (BGD) BARBADOS (BRB) BELARUS (BLR) BELGIUM (BEL) BELIZE (BLZ) BENIN (BEN) BERMUDA (BMU) BHUTAN (BTN) BOLIVIA (BOL) BONAIRE (BES) BOSNIA AND HERZEGOVINA (BIH) BOTSWANA (BWA) BOUVET ISLAND (BVT) BRAZIL (BRA) BRITISH COLUMBIA (BC-CAN) BRITISH INDIAN OCEAN TERRITORY (IOT) BRITISH VIRGIN ISLANDS (VGB) BRUNEI DARUSSALAM (BRN) BULGARIA (BGR) BURKINA FASO (BFA) BURUNDI (BDI) CALIFORNIA (CA) CAMBODIA (KHM) CAMEROON (CMR) CAMPECHE (CM-MX) CANADA (CAN) CAPE VERDE (CPV) CAYMAN ISLANDS (CYM) CENTRAL AFRICAN REPUBLIC (CAF) CHAD (TCD) CHIAPAS (CP-MX) CHIHUAHUA (CH-MX) CHILE (CHL) CHINA (CHN) CHRISTMAS ISLAND (CXR) COAHUILA (CA-MX) COCOS (KEELING) ISLANDS (CCK) COLIMA (CL-MX) COLOMBIA (COL) COLORADO (CO) COMOROS (COM) CONGO (COG) CONNECTICUT (CT) COOK ISLANDS (COK) COSTA RICA (CRI) COTE D'IVOIRE (CIV) CROATIA (HRV) CUBA (CUB) CURACAO (CUW) CYPRUS (CYP) CZECH REPUBLIC (CZE) DELAWARE (DE) DEMOCRATIC REPUBLIC OF THE CONGO (COD) DENMARK (DNK) DISTRICT OF COLUMBIA (DC) DISTRITO FEDERAL (DF-MX) DJIBOUTI (DJI) DOMINICA (DMA) DOMINICAN REPUBLIC (DOM) DURANGO (DU-MX) ECUADOR (ECU) EGYPT (EGY) EL SALVADOR (SLV) EQUATORIAL GUINEA (GNQ) ERITREA (ERI) ESTONIA (EST) ETHIOPIA (ETH) FALKLAND ISLANDS (MALVINAS) (FLK) FAROE ISLANDS (FRO) FIJI (FJI) FINLAND (FIN) FLORIDA (FL) FRANCE (FRA) FRENCH GUIANA (GUF) FRENCH POLYNESIA (PYF) FRENCH SOUTHERN TERRITORIES (ATF) GABON (GAB) GAMBIA (GMB) GEORGIA (GA) GERMANY (DEU) GHANA (GHA) GIBRALTAR (GIB) GREECE (GRC) GREENLAND (GRL) GRENADA (GRD) GUADELOUPE (GLP) GUAM (GU) GUANAJUATO (GT-MX) GUATEMALA (GTM) GUERNSEY (GGY) GUERRERO (GR-MX) GUINEA (GIN) GUINEA-BISSAU (GNB) GUYANA (GUY) HAITI (HTI) HAWAII (HI) HEARD ISLAND AND MCDONALD MCDONALD ISLANDS (HMD) HIDALGO (HG-MX) HOLY SEE (VATICAN CITY STATE) (VAT) HONDURAS (HND) HONG KONG (HKG) HUNGARY (HUN) ICELAND (ISL) IDAHO (ID) ILLINOIS (IL) INDIA (IND) INDIANA (IN) INDONESIA (IDN) IOWA (IA) IRAN (IRN) IRAQ (IRQ) IRELAND (IRL) ISLE OF MAN (IMN) ISRAEL (ISR) ITALY (ITA) JALISCO (JA-MX) JAMAICA (JAM) JAPAN (JPN) JERSEY (JEY) JORDAN (JOR) KANSAS (KS) KAZAKHSTAN (KAZ) KENTUCKY (KY) KENYA (KEN) KIRIBATI (KIR) KUWAIT (KWT) KYRGYZSTAN (KGZ) LAOS (LAO) LATVIA (LVA) LEBANON (LBN) LESOTHO (LSO) LIBERIA (LBR) LIBYA (LBY) LIECHTENSTEIN (LIE) LITHUANIA (LTU) LOUISIANA (LA) LUXEMBOURG (LUX) MACAO (MAC) MACEDONIA (MKD) MADAGASCAR (MDG) MAINE (ME) MALAWI (MWI) MALAYSIA (MYS) MALDIVES (MDV) MALI (MLI) MALTA (MLT) MANITOBA (MB-CANADA) MARSHALL ISLANDS (MHL) MARTINIQUE (MTQ) MARYLAND (MD) MASSACHUSETTS (MA) MAURITANIA (MRT) MAURITIUS (MUS) MAYOTTE (MYT) MEXICO (MX-MX,MEX) MICHIGAN (MI) MICHOACAN (MC-MX) MICRONESIA (FSM) MINNESOTA (MN) MISSISSIPPI (MS) MISSOURI (MO) MOLDOVA (MDA) MONACO (MCO) MONGOLIA (MNG) MONTANA (MT) MONTENEGRO (MNE) MONTSERRAT (MSR) MORELOS (MR-MX) MOROCCO (MAR) MOZAMBIQUE (MOZ) MYANMAR (MMR) NAMIBIA (NAM) NAURU (NRU) NAYARIT (NA-MX) NEBRASKA (NE) NEPAL (NPL) NETHERLANDS (NLD) NEVADA (NV) NEW BRUNSWICK (NB-CAN) NEW CALEDONIA (NCL) NEW HAMPSHIRE (NH) NEW JERSEY (NJ) NEW MEXICO (NM) NEW YORK (NY) NEW ZEALAND (NZL) NEWFOUNDLAND (NL-CAN) NICARAGUA (NIC) NIGER (NER) NIGERIA (NGA) NIUE (NIU) NORFOLK ISLAND (NFK) NORTH CAROLINA (NC) NORTH DAKOTA (ND) NORTH KOREA (PRK) NORTHERN MARIANA ISLANDS (MP) NORTHWEST TERRITORY (NT-CAN) NORWAY (NOR) NOVA SCOTIA (NS-CAN) NUEVO LEON (NL-MX) NUNAVUT (NU-CAN) OAXACA (OA-MX) OHIO (OH) OKLAHOMA (OK) OMAN (OMN) ONTARIO (ON-CAN) OREGON (OR) PAKISTAN (PAK) PALAU (PLW) PALESTINE (PSE) PANAMA (PAN) PAPUA NEW GUINEA (PNG) PARAGUAY (PRY) PENNSYLVANIA (PA) PERU (PER) PHILIPPINES (PHL) PITCAIRN (PCN) POLAND (POL) PORTUGAL (PRT) PRINCE EDWARD ISLAND (PE-CAN) PUEBLA (PU-MX) PUERTO RICO (PR) QATAR (QAT) QUEBEC (QC-CAN) QUERETARO (QE-MX) QUINTANA ROO (QR-MX) REUNION (REU) RHODE ISLAND (RI) ROMANIA (ROU) RUSSIA (RUS) RWANDA (RWA) SAINT BARTHELEMY (BLM) SAINT HELENA (SHN) SAINT KITTS AND NEVIS (KNA) SAINT LUCIA (LCA) SAINT MARTIN (FRENCH PART) (MAF) SAINT PIERRE AND MIQUELON (SPM) SAINT VINCENT AND THE GRENADINES (VCT) SAMOA (WSM) SAN LUIS POTOSI (SL-MX) SAN MARINO (SMR) SAO TOME AND PRINCIPE (STP) SASKATCHEWAN (SK-CAN) SAUDI ARABIA (SAU) SENEGAL (SEN) SERBIA (SRB) SEYCHELLES (SYC) SIERRA LEONE (SLE) SINALOA (SI-MX) SINGAPORE (SGP) SINT MAARTEN (DUTCH PART) (SXM) SLOVAKIA (SVK) SLOVENIA (SVN) SOLOMON ISLANDS (SLB) SOMALIA (SOM) SONORA (SO-MX) SOUTH AFRICA (ZAF) SOUTH CAROLINA (SC) SOUTH DAKOTA (SD) SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) SOUTH KOREA (KOR) SOUTH SUDAN (SSD) SPAIN (ESP) SRI LANKA (LKA) SUDAN (SDN) SURINAME (SUR) SVALBARD AND JAN MAYEN (SJM) SWAZILAND (SWZ) SWEDEN (SWE) SWITZERLAND (CHE) SYRIA (SYR) TABASCO (TB-MX) TAIWAN (TWN) TAJIKISTAN (TJK) TAMAULIPAS (TM-MX) TANZANIA (TZA) TENNESSEE (TN) TEXAS (TX) THAILAND (THA) TIMOR-LESTE (TLS) TLAXCALA (TL-MX) TOGO (TGO) TOKELAU (TKL) TONGA (TON) TRINIDAD AND TOBAGO (TTO) TUNISIA (TUN) TURKEY (TUR) TURKMENISTAN (TKM) TURKS AND CAICOS ISLANDS (TCA) TUVALU (TUV) UGANDA (UGA) UKRAINE (UKR) UNITED ARAB EMIRATES (ARE) UNITED KINGDOM (GBR) UNITED STATES (USA) UNITED STATES MINOR OUTLYING ISLANDS (UM) URUGUAY (URY) UTAH (UT) UZBEKISTAN (UZB) VANUATU (VUT) VENEZUELA (VEN) VERACRUZ (VE-MX) VERMONT (VT) VIET NAM (VNM) VIRGIN ISLANDS (VI) VIRGINIA (VA) WALLIS AND FUTUNA (WLF) WASHINGTON (WA) WEST VIRGINIA (WV) WESTERN SAHARA (ESH) WISCONSIN (WI) WYOMING (WY) YEMEN (YEM) YUCATAN (YU-MX) YUKON TERRITORY (YT-CAN) ZACATECAS (ZA-MX) ZAMBIA (ZMB) ZIMBABWE (ZWE)
County (Condado)	Phone (Teléfono)
Date of Birth (Fecha de Nacimiento - MM/dd/yyyy)	Birth State (Nacimiento Estado o Pais)
	AFGHANISTAN (AFG) AGUASCALIENTES (AG-MX) ALABAMA (AL) ALASKA (AK) ALBANIA (ALB) ALBERTA (AB-CAN) ALGERIA (DZA) AMERICAN SAMOA (AS) ANDORRA (AND) ANGOLA (AGO) ANGUILLA (AIA) ANTARCTICA (ATA) ANTIGUA AND BARBUDA (ATG) ARGENTINA (ARG) ARIZONA (AZ) ARKANSAS (AR) ARMED FORCES AFRICA (AE-AFR) ARMED FORCES AMERICAS (AA) ARMED FORCES CANADA (AE-CAN) ARMED FORCES EUROPE (AE-EUR) ARMED FORCES MIDDLE EAST (AE-ME) ARMED FORCES OTHERS (AE-OTHER) ARMED FORCES PACIFIC (AP) ARMENIA (ARM) ARUBA (ABW) AUSTRALIA (AUS) AUSTRIA (AUT) AZERBAIJAN (AZE) BAHAMAS (BHS) BAHRAIN (BHR) BAJA CALIFORNIA (BN-MX) BAJA CALIFORNIA SUR (BS-MX) BANGLADESH (BGD) BARBADOS (BRB) BELARUS (BLR) BELGIUM (BEL) BELIZE (BLZ) BENIN (BEN) BERMUDA (BMU) BHUTAN (BTN) BOLIVIA (BOL) BONAIRE (BES) BOSNIA AND HERZEGOVINA (BIH) BOTSWANA (BWA) BOUVET ISLAND (BVT) BRAZIL (BRA) BRITISH COLUMBIA (BC-CAN) BRITISH INDIAN OCEAN TERRITORY (IOT) BRITISH VIRGIN ISLANDS (VGB) BRUNEI DARUSSALAM (BRN) BULGARIA (BGR) BURKINA FASO (BFA) BURUNDI (BDI) CALIFORNIA (CA) CAMBODIA (KHM) CAMEROON (CMR) CAMPECHE (CM-MX) CANADA (CAN) CAPE VERDE (CPV) CAYMAN ISLANDS (CYM) CENTRAL AFRICAN REPUBLIC (CAF) CHAD (TCD) CHIAPAS (CP-MX) CHIHUAHUA (CH-MX) CHILE (CHL) CHINA (CHN) CHRISTMAS ISLAND (CXR) COAHUILA (CA-MX) COCOS (KEELING) ISLANDS (CCK) COLIMA (CL-MX) COLOMBIA (COL) COLORADO (CO) COMOROS (COM) CONGO (COG) CONNECTICUT (CT) COOK ISLANDS (COK) COSTA RICA (CRI) COTE D'IVOIRE (CIV) CROATIA (HRV) CUBA (CUB) CURACAO (CUW) CYPRUS (CYP) CZECH REPUBLIC (CZE) DELAWARE (DE) DEMOCRATIC REPUBLIC OF THE CONGO (COD) DENMARK (DNK) DISTRICT OF COLUMBIA (DC) DISTRITO FEDERAL (DF-MX) DJIBOUTI (DJI) DOMINICA (DMA) DOMINICAN REPUBLIC (DOM) DURANGO (DU-MX) ECUADOR (ECU) EGYPT (EGY) EL SALVADOR (SLV) EQUATORIAL GUINEA (GNQ) ERITREA (ERI) ESTONIA (EST) ETHIOPIA (ETH) FALKLAND ISLANDS (MALVINAS) (FLK) FAROE ISLANDS (FRO) FIJI (FJI) FINLAND (FIN) FLORIDA (FL) FRANCE (FRA) FRENCH GUIANA (GUF) FRENCH POLYNESIA (PYF) FRENCH SOUTHERN TERRITORIES (ATF) GABON (GAB) GAMBIA (GMB) GEORGIA (GA) GERMANY (DEU) GHANA (GHA) GIBRALTAR (GIB) GREECE (GRC) GREENLAND (GRL) GRENADA (GRD) GUADELOUPE (GLP) GUAM (GU) GUANAJUATO (GT-MX) GUATEMALA (GTM) GUERNSEY (GGY) GUERRERO (GR-MX) GUINEA (GIN) GUINEA-BISSAU (GNB) GUYANA (GUY) HAITI (HTI) HAWAII (HI) HEARD ISLAND AND MCDONALD MCDONALD ISLANDS (HMD) HIDALGO (HG-MX) HOLY SEE (VATICAN CITY STATE) (VAT) HONDURAS (HND) HONG KONG (HKG) HUNGARY (HUN) ICELAND (ISL) IDAHO (ID) ILLINOIS (IL) INDIA (IND) INDIANA (IN) INDONESIA (IDN) IOWA (IA) IRAN (IRN) IRAQ (IRQ) IRELAND (IRL) ISLE OF MAN (IMN) ISRAEL (ISR) ITALY (ITA) JALISCO (JA-MX) JAMAICA (JAM) JAPAN (JPN) JERSEY (JEY) JORDAN (JOR) KANSAS (KS) KAZAKHSTAN (KAZ) KENTUCKY (KY) KENYA (KEN) KIRIBATI (KIR) KUWAIT (KWT) KYRGYZSTAN (KGZ) LAOS (LAO) LATVIA (LVA) LEBANON (LBN) LESOTHO (LSO) LIBERIA (LBR) LIBYA (LBY) LIECHTENSTEIN (LIE) LITHUANIA (LTU) LOUISIANA (LA) LUXEMBOURG (LUX) MACAO (MAC) MACEDONIA (MKD) MADAGASCAR (MDG) MAINE (ME) MALAWI (MWI) MALAYSIA (MYS) MALDIVES (MDV) MALI (MLI) MALTA (MLT) MANITOBA (MB-CANADA) MARSHALL ISLANDS (MHL) MARTINIQUE (MTQ) MARYLAND (MD) MASSACHUSETTS (MA) MAURITANIA (MRT) MAURITIUS (MUS) MAYOTTE (MYT) MEXICO (MX-MX,MEX) MICHIGAN (MI) MICHOACAN (MC-MX) MICRONESIA (FSM) MINNESOTA (MN) MISSISSIPPI (MS) MISSOURI (MO) MOLDOVA (MDA) MONACO (MCO) MONGOLIA (MNG) MONTANA (MT) MONTENEGRO (MNE) MONTSERRAT (MSR) MORELOS (MR-MX) MOROCCO (MAR) MOZAMBIQUE (MOZ) MYANMAR (MMR) NAMIBIA (NAM) NAURU (NRU) NAYARIT (NA-MX) NEBRASKA (NE) NEPAL (NPL) NETHERLANDS (NLD) NEVADA (NV) NEW BRUNSWICK (NB-CAN) NEW CALEDONIA (NCL) NEW HAMPSHIRE (NH) NEW JERSEY (NJ) NEW MEXICO (NM) NEW YORK (NY) NEW ZEALAND (NZL) NEWFOUNDLAND (NL-CAN) NICARAGUA (NIC) NIGER (NER) NIGERIA (NGA) NIUE (NIU) NORFOLK ISLAND (NFK) NORTH CAROLINA (NC) NORTH DAKOTA (ND) NORTH KOREA (PRK) NORTHERN MARIANA ISLANDS (MP) NORTHWEST TERRITORY (NT-CAN) NORWAY (NOR) NOVA SCOTIA (NS-CAN) NUEVO LEON (NL-MX) NUNAVUT (NU-CAN) OAXACA (OA-MX) OHIO (OH) OKLAHOMA (OK) OMAN (OMN) ONTARIO (ON-CAN) OREGON (OR) PAKISTAN (PAK) PALAU (PLW) PALESTINE (PSE) PANAMA (PAN) PAPUA NEW GUINEA (PNG) PARAGUAY (PRY) PENNSYLVANIA (PA) PERU (PER) PHILIPPINES (PHL) PITCAIRN (PCN) POLAND (POL) PORTUGAL (PRT) PRINCE EDWARD ISLAND (PE-CAN) PUEBLA (PU-MX) PUERTO RICO (PR) QATAR (QAT) QUEBEC (QC-CAN) QUERETARO (QE-MX) QUINTANA ROO (QR-MX) REUNION (REU) RHODE ISLAND (RI) ROMANIA (ROU) RUSSIA (RUS) RWANDA (RWA) SAINT BARTHELEMY (BLM) SAINT HELENA (SHN) SAINT KITTS AND NEVIS (KNA) SAINT LUCIA (LCA) SAINT MARTIN (FRENCH PART) (MAF) SAINT PIERRE AND MIQUELON (SPM) SAINT VINCENT AND THE GRENADINES (VCT) SAMOA (WSM) SAN LUIS POTOSI (SL-MX) SAN MARINO (SMR) SAO TOME AND PRINCIPE (STP) SASKATCHEWAN (SK-CAN) SAUDI ARABIA (SAU) SENEGAL (SEN) SERBIA (SRB) SEYCHELLES (SYC) SIERRA LEONE (SLE) SINALOA (SI-MX) SINGAPORE (SGP) SINT MAARTEN (DUTCH PART) (SXM) SLOVAKIA (SVK) SLOVENIA (SVN) SOLOMON ISLANDS (SLB) SOMALIA (SOM) SONORA (SO-MX) SOUTH AFRICA (ZAF) SOUTH CAROLINA (SC) SOUTH DAKOTA (SD) SOUTH GEORGIA AND THE SOUTH SANDWICH ISLANDS (SGS) SOUTH KOREA (KOR) SOUTH SUDAN (SSD) SPAIN (ESP) SRI LANKA (LKA) SUDAN (SDN) SURINAME (SUR) SVALBARD AND JAN MAYEN (SJM) SWAZILAND (SWZ) SWEDEN (SWE) SWITZERLAND (CHE) SYRIA (SYR) TABASCO (TB-MX) TAIWAN (TWN) TAJIKISTAN (TJK) TAMAULIPAS (TM-MX) TANZANIA (TZA) TENNESSEE (TN) TEXAS (TX) THAILAND (THA) TIMOR-LESTE (TLS) TLAXCALA (TL-MX) TOGO (TGO) TOKELAU (TKL) TONGA (TON) TRINIDAD AND TOBAGO (TTO) TUNISIA (TUN) TURKEY (TUR) TURKMENISTAN (TKM) TURKS AND CAICOS ISLANDS (TCA) TUVALU (TUV) UGANDA (UGA) UKRAINE (UKR) UNITED ARAB EMIRATES (ARE) UNITED KINGDOM (GBR) UNITED STATES (USA) UNITED STATES MINOR OUTLYING ISLANDS (UM) URUGUAY (URY) UTAH (UT) UZBEKISTAN (UZB) VANUATU (VUT) VENEZUELA (VEN) VERACRUZ (VE-MX) VERMONT (VT) VIET NAM (VNM) VIRGIN ISLANDS (VI) VIRGINIA (VA) WALLIS AND FUTUNA (WLF) WASHINGTON (WA) WEST VIRGINIA (WV) WESTERN SAHARA (ESH) WISCONSIN (WI) WYOMING (WY) YEMEN (YEM) YUCATAN (YU-MX) YUKON TERRITORY (YT-CAN) ZACATECAS (ZA-MX) ZAMBIA (ZMB) ZIMBABWE (ZWE)
Ever Married (Anteriorment se casó?)	Number of this Marriage (Número de este matrimonio)
Last Marriage Ended Date (Fecha de matrimonio anterior - MM/dd/yyyy)	Marriage Ended (Ultimo Martrimonio Termino Por)
	--Select One-- Annulment Death Divorce