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Marriage Location:           
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Performed by:                
Witnesses:                   

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

Groom Father Name:           
Immigrant ID:                CYMR-12NOV1904-3-P-0009 
Birth Place:                 

Groom Mother Name:           
Immigrant ID:                CRTH-10NOV1907-3-1-0013 
Birth Place:                 

Bride Father Name:           
Immigrant ID:                
Birth Place:                 

Bride Mother Name:           
Immigrant ID:                
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Comments:
                             groom's father deceased, age: 48, occupation: shoeworker / groom's mother's residence: Lynn, MA, age: 44, occupation: seamstress / bride's father deceased, age: 30, occupation: merchant / bride's mother's residence: Salem, MA, age: 46, occupation: at home