Page 53 - 2022_03 Resource Guide
P. 53

Obituary Form, Cont.


            Survivors:


                         Name                         Relationship                 Residence: City & State
            _____________________           _____________________            _____________________

            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________

            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________

            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________

            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________

            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________
            _____________________           _____________________            _____________________



            Preceded In Death By:  _________________________________________________
            ____________________________________________________________________
            ____________________________________________________________________
            ____________________________________________________________________

            ____________________________________________________________________
            ____________________________________________________________________

            Which Newspapers:  ___________________________________________________
            ____________________________________________________________________
            ____________________________________________________________________



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