Email address:* | |
Event:*DeathInterment | Name of Deceased:* |
Date of Death:*
Date of Interment: |
Location of Death:
Location of Interment: |
Name of Spouse: | Residence at Time of Death: |
Name of Father: | Names of Children: |
Name of Mother: | Names of Siblings: |
Source of Information:
Vital Records Published Works (newspaper,etc) Specify: |
Personal Knowledge Other (please specify): |
Other Pertinent Info:
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