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VITAL STATISTICS FORM Name Phone Address County Social Security Formerly of Date of Death CODE Years Zip Time Date of Birth Age Place of Death City Birthplace Veteran Marital Surviving Spouse Job Industry Last Employer Retired Race Spanish Education Father Mother s Maiden Name Informant Relation Informant Address State Cemetery Cause of Death Doctor SURVIVOR S Mother Spouse Children Brothers Sisters Grand Parents Great Grandchildren Great Great Grandchildren COMMUNITY FUNERAL HOME 257...
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Formerly of is a form that must be filed with the appropriate authority to report a change in information.
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