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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Name of Bride/Groom''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Name of Bride/Groom''' | ||
| valign="middle" align="center" width="16%" | | | valign="middle" align="center" width="16%" | | ||
| valign="middle" align="center" width="16%" | | | valign="middle" align="center" width="16%" | | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Date of Marriage''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Date of Marriage''' | ||
| valign="middle" align="center" width="16%" | | | valign="middle" align="center" width="16%" | | ||
| valign="middle" align="center" width="16%" | | | valign="middle" align="center" width="16%" | | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Location of Marriage''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Location of Marriage''' | ||
| valign="middle" align="center" width="16%" | | | valign="middle" align="center" width="16%" | | ||
| valign="middle" align="center" width="16%" | | | valign="middle" align="center" width="16%" | | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Presiding Official''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Presiding Official''' | ||
| valign="middle" align="center" width="16%" | | | valign="middle" align="center" width="16%" | | ||
| valign="middle" align="center" width="16%" | | | valign="middle" align="center" width="16%" | | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Date of Birth''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Date of Birth''' | ||
| valign="middle" align="center" width="16%" | <br> | | valign="middle" align="center" width="16%" | <br> | ||
| valign="middle" align="center" width="16%" | | | valign="middle" align="center" width="16%" | | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Place of Birth''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Place of Birth''' | ||
| valign="middle" align="center" width="16%" | <br> | | valign="middle" align="center" width="16%" | <br> | ||
| valign="middle" align="center" width="16%" | ''' | | valign="middle" align="center" width="16%" | ''' ''' | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Residence at Time of Marriage''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Residence at Time of Marriage''' | ||
| valign="middle" align="center" width="16%" | <br> | | valign="middle" align="center" width="16%" | <br> | ||
| valign="middle" align="center" width="16%" | ''' | | valign="middle" align="center" width="16%" | ''' ''' | ||
|} | |} | ||