| Name |
|
| Born
|
|
| Died
|
|
| Survived by |
| Name |
Relationship |
City |
State |
| |
|
|
|
| |
|
|
|
| |
|
|
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| |
|
|
|
| |
|
|
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| |
|
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| |
|
|
|
| |
|
|
|
| ________ | Children |
________ | Grandchildren |
________ | Great Grandchildren |
|
| Preceeded by |
| Name |
Relationship |
City |
State |
| |
|
|
|
| |
|
|
|
| |
|
|
|
| |
|
|
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| |
|
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| |
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| |
|
|
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| |
|
|
|
|
| Arrangements by |
|
| Visitation |
|
| Services |
| |
|
|
| Date |
Place |
|
| |
|
|
| Time |
Address |
|
| |
|
|
| Officiated by |
City |
State |
|
| Cemetary |
|
Graveside Services |
|