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| {| width="31%" cellspacing="1" cellpadding="5" border="1" style="float: right;"
| | <noinclude>[[Category:Templates for WA pages]]</noinclude> |
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| | width="31%" bgcolor="#B2B2FF" colspan="3" |<center>'''Birth Records''' reveal</center>
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| | width="25%" | <center>'''Y'''es or '''M'''aybe --></center>
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| | width="3%" | '''Y'''
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| | width="3%" | '''M'''
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| |-
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| | width="25%" bgcolor="#CCFFFF" | Names of Bride and Groom
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| | width="3%" | {{Green check}}
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| | width="3%" |
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| | width="25%" bgcolor="#CCFFFF" | Ages
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| | width="3%" | {{Green check}}
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| | width="3%" |
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| |-
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| | width="25%" bgcolor="#CCFFFF" | Birth Places
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| | width="3%" | {{Green check}}
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| | width="3%" |
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| | width="25%" bgcolor="#CCFFFF" | Residences
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| | width="3%" |
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| | width="3%" | {{Green check}}
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| | width="25%" bgcolor="#CCFFFF" | Names of Parents
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| | width="3%" | {{Green check}}
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| | width="3%" |
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| | width="25%" bgcolor="#CCFFFF" | Witnesses
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| | width="3%" | {{Green check}}
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| | width="3%" |
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| | width="25%" bgcolor="#CCFFFF" | Minister or Officiator
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| | width="3%" | {{Green check}}
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| | width="3%" |
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| |}
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