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Husband's Information

First Name

Middle Name

Last Name

Phone Number

Home Address

Home City

Home State

Date Of Birth (DD/MM/YYYY)

Location Of Birth (City/County/State)

Date Of Baptism Or Christening (DD/MM/YYYY)

Location Of Baptism Or Christening (Place/City/County/State)

Date Of Marriage (DD/MM/YYYY)

Location Of Marriage (Place/City/County/State)

Date Of Death (DD/MM/YYYY)

Location Of Death (City/County/State)

Date Of Burial (DD/MM/YYYY)

Location Of Burial (Place/City/County/State)

Cause Of Death

Father's Full Name (First/Middle/Last)

Mother's Full Maiden Name (First/Middle/Last)

Wife's Information

First Name

Middle Name

Maiden Last Name

Date Of Birth (DD/MM/YYYY)

Location Of Birth (City/County/State)

Date Of Baptism Or Christening (DD/MM/YYYY)

Location Of Baptism Or Christening (Place/City/County/State)

Date Of Death (DD/MM/YYYY)

Location Of Death (City/County/State)

Date Of Burial (DD/MM/YYYY)

Location Of Burial (Place/City/County/State)

Cause Of Death

Father's Full Name (First/Middle/Last)

Mother's Full Maiden Name (First/Middle/Last)

First Child

Child's First Name

Child's Middle Name

Child's Last Name

Sex

Male Female

Date Of Birth (DD/MM/YYYY)

Location Of Birth (City/County/State)

Date Of Baptism Or Christening (DD/MM/YYYY)

Location Of Baptism Or Christening (Place/City/County/State)

Date Of Death (DD/MM/YYYY)

Location Of Death (City/County/State)

Date Of Burial (DD/MM/YYYY)

Location Of Burial (Place/City/County/State)

Cause Of Death

Second Child

Child's First Name

Child's Middle Name

Child's Last Name

Sex

Male Female

Date Of Birth (DD/MM/YYYY)

Location Of Birth (City/County/State)

Date Of Baptism Or Christening (DD/MM/YYYY)

Location Of Baptism Or Christening (Place/City/County/State)

Date Of Death (DD/MM/YYYY)

Location Of Death (City/County/State)

Date Of Burial (DD/MM/YYYY)

Location Of Burial (Place/City/County/State)

Cause Of Death

Third Child

Child's First Name

Child's Middle Name

Child's Last Name

Sex

Male Female

Date Of Birth (DD/MM/YYYY)

Location Of Birth (City/County/State)

Date Of Baptism Or Christening (DD/MM/YYYY)

Location Of Baptism Or Christening (Place/City/County/State)

Date Of Death (DD/MM/YYYY)

Location Of Death (City/County/State)

Date Of Burial (DD/MM/YYYY)

Location Of Burial (Place/City/County/State)

Cause Of Death

Fourth Child

Child's First Name

Child's Middle Name

Child's Last Name

Sex

Male Female

Date Of Birth (DD/MM/YYYY)

Location Of Birth (City/County/State)

Date Of Baptism Or Christening (DD/MM/YYYY)

Location Of Baptism Or Christening (Place/City/County/State)

Date Of Death (DD/MM/YYYY)

Location Of Death (City/County/State)

Date Of Burial (DD/MM/YYYY)

Location Of Burial (Place/City/County/State)

Cause Of Death

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