Questionnaire Text

Questionnaire form view entire document:  text  image

[Questions 1 - 9 were asked of all persons]


6. Marital status:

[] Single
[] Married

________ Date of marriage (day, month, year)

[] Widowed
[] Divorced


For Question 6, Marital status: The date of the marriage should only be given by married persons, namely for existing marriages.