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For Immediate Assistance, Call (256) 378-7199

For Immediate Assistance, Call (256) 378-7199

Home
About Us
Obituaries

Services
Grief Support
Resources

Services

Vital Statistics Information Form

Personal/Descendant Information

Vital Statistics Information Form

Prefix

First Name

Middle Name

Last Name

Street

City

Sate/Province

Zip/Postal Code

Sex

Male

Female

Suffix

SSN #

Date of Birth

Age

State of Birth (U=Unknown)

City of Birth (U=Unknown)

County of Birth (U=Unknown)

Country of Birth

Burial or Cremation?

Burial

Cremation

Place of Disposition

Address of Cemetery/Crematory

Descendant Street

Descendant City

Descendant State/Province

Descendant Zip/Postal Code

Education of Descendant

High School

Associate's Degree

Bachelor's Degree

Doctorate's Degree

Descendant Inside City Limits?

Yes

No

Was Descendant in the Miliart or Armed Forces?

Yes

No

Descendant's Last Occupation (U=Unknown)

Kind of Business or Industry (U=Unknown)

Last Employer

Marital Status

Spouse's Full name (First, Middle, Last) (If Wife, Give Maiden Name

Descendant's Father's Full Name (First, Middle, Last)

Date of Death

New Field:

Race of Deceased

Cremation or Burial

Yes

No

Cemetery Intend On Using

Yes

No

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