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Vital Statistic Form
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A Death Has Occurred
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Please use this form to get started on pre-planning or arranging a service of your choice.
Last Name
Given Name
Date
Full Burial
Yes
Cremation
Yes
Address
City
Postal Code
Date of Birth
Date of Death
Place of Birth
Place of Death
Age
Marital Status
Occupation
Type of Industry
Name of Mother
Birthplace
Mothers Maiden Name
Phone Number
Gender
Select one...
Male
Female
S.I.N.
Name of Informant
Relationship
Address
Spouse Name
Maiden Name
Date of Birth
Survivor Information
Select one...
Husband
Wife
Sisters
Sons
Daughters
Brothers
Number of Grandchildren
Number of Great Grandchildren
Notes
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