3. Date of birth
Print day, month and year.
Example: If this person was born on the 10th of February 1945, enter:
If exact date is not known, enter best estimate.
Day _ _
Month _ _
Year 1_ _ _
5. Legal marital status.
Mark one circle only.
[] Legally married (and not separated)
[] Legally married and separated
[] Divorced
[] Widowed
[] Never married (single)