Personal Information

Full Name
[unknown]
Notable
Last Name
[unknown]
First Name
Middle Name
Suffix
Prefix
Maiden Name
Time lived in city
Address
Occupation
Unemployed
Age at Death
X

Dates

Date of Birth
/ /
Date of Death
/ /

Locations

Birthplace
Hospital
Father's Birthplace
Mother's Birthplace

Burial

Death Certificate
Cause of Death
Accidental
Undertaker
Huckaby Funeral Service
Plot#
Inscription

Family

Spouse's Name
Marital Status
Father's Name
,
Mother's Name
,