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ALTUS    ·    580-482-1800    ·    ELDORADO

NAME:         

MAIDEN:     

ADDRESS:      

CITY:              STATE:   

FAMILY PHONE #            OR          

SOCIAL SECURITY #       RACE:          

SEX:                     MARTIAL STATUS:  

SPOUSE'S NAME:                               DATE   MARRIED                 WHERE

DATE OF BIRTH:               AGE:      
PLACE OF BIRTH:   

OCCUPATION:               

EMPLOYER:            

MILITARY INFORMATION:

BRANCH OF SERVICE:          SERIAL #  

RANK:        DOE:       DOS:   

FATHER'S NAME:    

PLACE OF BIRTH:   

MOTHER (MAIDEN):     

PLACE OF BIRTH:   

CHURCH MEMBERSHIP:        

CITY & STATE:    

ORGANIZATIONS:

EDUCATION:

HISTORY:

HOBBIES /INTERESTS:

FUNERAL SERVICE TO BE HELD:

MINISTER:

(1)  

(2)   

(3)  

MUSIC:                   

SOLOIST:          

ORGANIST:  

SONGS:   

(1)   

(2)   

(3)   

(4)   

CEMETERY LOTS:    

PALLBEARER  (ACTIVE)

(1)      (5)  

(2)      (6)  

(3)      (7)  

(4)      (8)  

PALLBEARER  (HONORARY)

(1)      (5)   

(2)      (6)   

(3)      (7)   

(4)      (8)   

PRECEDED IN DEATH BY:

SURVIVING RELATIVES:

SPOUSE:    

DAUGHTERS:                               CITY/STATE:              SONS:                                            CITY/STATE:

SISTERS:                                      CITY/STATE:               BROTHERS:                                  CITY/STATE:

PARENTS:   

PATERNAL GRANDPARENTS:    

MATERNAL GRANDPARENTS:   

GRANDCHILDREN   

GREAT-GRANDCHILDREN  

GREAT-GREAT-GRANDCHILDREN