Natural father's application. Name: _________ Home address: _________ Home phone No.: _________ Occupation: _________ Place of employment: _________ Age: _________ Birth date: _________ Height: _________ Weight: _________ Hair: _________ Eyes: _________ Race: _________ Religion: _________ Complexion: _________ Ethnic: _________ Blood type: _________
Business phone No.: _________ Number of children: _________ Natural or adopted? _________ Ages: _________
Combined Annual Congenital diseases income of yourself within your family: _________ and your spouse: _________ Date of present marriage: _________ Number of previous marriages: _________ Have you had a recent sperm count? _________ If so, the date and if possible, attach a copy of results: _________
Please attach a recent photograph and a copy of your marriage license.