Applicant A Information
1. Name: (First, Middle, Last) * *
2. Birth Last Name	3. Gender	4. Domestic Partnership #
	M F U
5. Date of Birth *	6. Birth City*	7. Birth State (If Not USA Give Country)*
8. Present Street Address (Number and Street)*	9. City/Town/Location*	10. State
		Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside the U.S.
11. County*	12. Inside City Limits*	13. Address Past 6 Months (If Same, Leave Blank)
	Yes No
14. Marital Status	15. Occupation *
Single Divorced Widowed
16. Father's Name (First/Last) * *	17. Birth State (If Not USA Give Country) *
18. Mother's Maiden Name (First/Last) * *	19. Birth State (If Not USA Give Country) *

Applicant B Information
1. Name: (First, Middle, Last) * *
2. Birth Last Name	3. Gender	4. Domestic Partnership #
	M F U
5. Date of Birth*	6. Birth City *	7. Birth State (If Not USA Give Country)*
8. Present Street Address (Number and Street)*	9. City/Town/Location*	10. State
		Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Outside of the U.S.
11. County*	12. Inside City Limits*	13. Address Past 6 Months (If Same, Leave Blank)
	Yes No
14. Marital Status	15. Occupation*
Single Divorced Widowed
16. Father's Name (First/Last) * *	17. Birth State (If Not USA Give Country) *
18. Mother's Maiden Name (First/Last) * *	19. Birth State (If Not USA Give Country) *