1 - ESDS

TO THOSE CURRENTLY LIVING W7iH SOME oNE AS A COUPLE BUT
NOT LEGALLY fAARRJED II n=O
Man .4d you and yaw pwtm.r smrlIwmgtogaunr as a caupto? 1’
DWQ7M-7H owa7YR Month Yur I
Enter Month and Year -- . -----
“ t--t””w’
I
Dwaa Has yourpattnerwar bean bgally mamnd? Im
Yes [0]
No [0] —G0t0Dm9
Dwa9 Have you any stop,fader or adoplmdchldren of any age who Ike
with you?
m
Y*S
No
[0]
[14] l--
— GOto DVA21OPR
Ga to Dwll
❑W9tOPR Enter the c+vld’sflintname
OWQI 0S7 He/sha IS
Pbnss ●nter the detmh of yourstapifosterhdoptadduld(ran) bcbw
step
Fo8tar
Ado@ad
OWQIOBM Data of bnth Month
owatoBY Year
OWQI OLM Data he/sha bqpn Nwngwth YOU Month
DWQ1OLY Year
1at child
- --.”
mg~:
19
19
[0]
[0]
[0]
2nd child
----
Rll
I
Xd child
---
ull~
I
4th child
-----
—GOtoowll
1
290