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* Asterisk indicates data needs to be entered - skip any other unknown field.
First Name: *    M/F:  Nickname:

Middle Name:

Maiden Name:
Last Name: *   Sr/Jr:
Address1: (optional)
Address2: (optional)

City:

*              If Not USA - Country:

County:

* State:  *  Zip:  -

E-Mail Address:

  Phone:  -- (optional)

Date of Birth:

--*  MM-DD-YYYY Father's Full Name:

City:

Mother's Full 
(Maiden) Name:

County:

  State:      Country:

Marriage-Date:

--    MM-DD-YYYY

City:

County:

  State:      Country:
Christening/Baptism:

Date:

--    MM-DD-YYYY     

City:

County:

  State:      Country:

Death-Date:

--    MM-DD-YYYY

City:

County:

  State:      Country:
Burial/Cremation:            Burial Plot (if available):  

Date:

--    MM-DD-YYYY                    Plot Example: West Park Cemetery,
            Sec 15, Tier 40, Grave 41 (3942 Ridge Rd.)
City:
County:    State:      Country: 
Notes:
(Such things as:)
Background
Military Service
Education
Occupation
Interests
Illnesses
If same as above,
enter:
Same

 

 

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Submitter's Full Name:

Submitter's E-Mail:
*
Submitter's City, State:

          Submit will send us the information to our E-mail.

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