PERSONAL INFORMATION FORMThe first step is to submit your information using the form below. First Name * Middle Name * Last Name * Previous Last Name * Birth Date * MM DD YYYY Country of birth * City/Town/Village of birth * Marriage Date * MM DD YYYY Country of Marriage * City/Town/Village of Marriage * Civil or Religious Marriage? Civil Religious County of Residence * In New York State Since * MM DD YYYY Children in Common (write "None" or continue below) 1st Child First Middle Last Name and Date of Birth DD/MM/YYY 2nd Child First Middle Last Name and Date of Birth DD/MM/YYY 3rd Child First Middle Last Name and Date of Birth DD/MM/YYY 4th Child First Middle Last Name and Date of Birth DD/MM/YYY Home Ownership * Do you and/or your spouse own real property (house/condo)? Yes No Phone Number * Country (###) ### #### Email * Address Address 1 Address 2 City State/Province Zip/Postal Code Country Health Insurance * Thank you! Please don’t hesitate to reach out wih any questions. We promise a fast response.