ivorced separated widowed , 18. Spouse's full name (il dinorced or separated. please iidioste maiden name if applicable) 19. Spouse's date of bIrth (ddimmyy) 20. Spouse's place of bInh "21. Your father's full name SEYMOUR EPSTEIN n22. Your mother's full name PAULA EPSTEIN 23. Have you ever b

ns subsecti el I. fieregistration shall Meidde any chemise to the, following information: 1, Name; sotsal socUrity nurober; age; race; sex; dato of bIrth; hoight; weIght; halt and mp colon addrecs of any permanent rendene and addrets of any cirront temporary resIdence, within the stabs or out of stat