Page 47 - Gallaway & Crane Funeral Home, Inc.

Gallaway and Crane Funeral Home, Inc.
Name of Deceased Date of Death Place of Birth (City or Town) County
Name of Hospital or Institution (If not either, give No. & Street)
Residence (No. & Street)
County
Marital Status Single
Decedent’s Education: Degree obtained (if any)
Zip
State Married
City/Town
Separated Widowed
Yes
No Divorced
Inside City Limits
Was Deceased ever in U.S. Military War
Sex Date of Birth Birthplace
Yes No
If Yes, Branch of service Date From
to
Age at Last Birthday Citizen of What Country
Surviving Spouse (If Wife, Maiden Name) Social Security Number
Race
White Black American Indian Italian German
Ethnic Origin
Puerto Rican
Cuban
Mexican
Name & Address of Last Employer
Usual Occupation (kind of work done most of life, even if retired) Kind of Business Industry
Name of Father (first, middle, last)
Maiden Name of Mother (first, middle, last)
Name of informant No. & Street Hairdresser Disposition
Relationship City/Town
Phone
State Zip
Removal
State
Block No
At
Yes
No
Burial Name of Cemetery or Crematory
Cremation
Other
City or Town Lot No Church Clergy
Obits
Doctors Name Embalming
Sec No Service on
Yes No
Visitation Hours
# of Death Certificate
Dr. Phone
GALLAWAY & CRANE FUNERAL HOME INC. - Page 47