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Marriage Date:               
Performed by:                
Witnesses:                   

Groom Name:                  
Immigrant ID:                
Age:                          years 
Birth Date:                  
Occupation:                  
Marital Status:              
Home Address:                
Birth Place:                 

Bride Name:                  
Immigrant ID:                
Age:                          years 
Birth Date:                  
Occupation:                  
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Groom Father Name:           
Immigrant ID:                
Birth Place:                 

Groom Mother Name:           
Immigrant ID:                
Birth Place:                 

Bride Father Name:           
Immigrant ID:                KROW-03JUN1903-2-Z-0029 
Birth Place:                 

Bride Mother Name:           
Immigrant ID:                KROW-03JUN1903-2-Z-0030 
Birth Place:                 


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