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Information

Name

Age

Resident of (City, State)

Formerly of (City, State)

Place

How

Born

Place of Birth

Occupation

Church Affiliation

Veteran of

Organizations

Other Affiliations

RELATIVES

Son or Daughter of

Preceding in Death

Husband or Wife

Mother

Father

Sons (If multiple seperate names by comma)

Daughters (If multiple seperate names by comma)

Brothers (If multiple seperate names by comma)

Sisters (If multiple seperate names by comma)

Grandchildren (If multiple seperate names by comma)

Great Grandchildren (If multiple seperate names by comma)

Cemetery

Memorial Contributions

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Your Email (required)

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