Direct Cremation

Deceased Information
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Parents Information
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Marital Information
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Informant Information
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Disposition
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Doctor Information
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Military Status
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Funeral Home Information (Do we need this?)
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Survivor Information
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Funeral Service Information
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Charities & Service Groups
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Church Information
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Pallbearers

Deceased Name & Residence

Title*:

First Name*:

Middle Name:

Last Name*:

Ext.:

Maiden Name:

Gender*:

Address

Address:

City:

Country:

State/Province:

Zip/Postal code:

County:

Municipality:

Years At Residence:

Formerly of:

Place of Death

Date of Death*:

Time of Death:

Time Unknown:

Yes

Place of Death Type:

This should be a drop down filled by the rolodex

Place of Death Name:

Address

Address:

City:

Country:

State/Province:

Zip/Postal code:

County:

Municipality:

Coroner Contacted:

Cause of Death:

Length of Illness:

Birth Information

Date of Birth:

Age at Death:

City of Birth:

Prov/State of Birth:

County of Birth:

Country:

Social Security Number:

Education & Occupation

Education Years:

Education Notes:

Occupation:

Number of Years:

Kind of Business:

Employer:

Retired:

Year Retired:

Work History:

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Direct Cremation

Deceased Information

Parents Information

Marital Information

Informant Information

Disposition

Doctor Information

Military Status

Funeral Home Information (Do we need this?)

Survivor Information

Funeral Service Information

Charities & Service Groups

Church Information

Pallbearers

Address

Address

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