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Get State Of Utah - Department Of Health Application For ... - Tooele County

Dress Middle Street & Number Last City, Town or Location Zip Code Date of Birth Month / Day / Year State of Birth Race - Groom White, Black, Am Indian, Etc Age County Social Security # Number This Marriage If Previously Married First, Second, Etc. Last marriage ended by death, divorce, Date Ended annulment, etc. Month/Year Groom s Father Name (First Middle Last) State of Birth State Education Through high school 12 yrs, add one for any additional years Groom s Mother.

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