Information Needed For: Newspaper, Obituary & Death Certificate (Page 2 of 2) in pdf

* * * SURVIVING FAMILY INFORMATION * * *

* * * List All Living Relatives * * *

Spouse _____________________________________________________ City _________________________________

Father ______________________________________________________ City _________________________________

Mother _____________________________________________________ City __________________________________

Sons _______________________________________________________ City __________________________________

2. _________________________________________________________ City __________________________________

3. _________________________________________________________ City __________________________________

4. _________________________________________________________ City __________________________________

5. _________________________________________________________ City __________________________________

Daughters __________________________________________________ City ___________________________________

2. _________________________________________________________ City __________________________________

3. _________________________________________________________ City __________________________________

4. _________________________________________________________ City __________________________________

5. _________________________________________________________ City __________________________________

Brothers ___________________________________________________ City ___________________________________

2. _________________________________________________________ City __________________________________

3. _________________________________________________________ City __________________________________

4. _________________________________________________________ City __________________________________

5. _________________________________________________________ City __________________________________

Sisters _____________________________________________________ City __________________________________

2. _________________________________________________________ City __________________________________

3. _________________________________________________________ City __________________________________

4. _________________________________________________________ City __________________________________

5. _________________________________________________________ City __________________________________

Number of Grand Children __________ Great Grand Children __________ Great Great Grand Children ________

Preceded in Death by ________________________________________________________________________________

__________________________________________________________________________________________________

Information Needed For: Newspaper, Obituary & Death Certificate Page 2