Biographic Questionnaire
Some of the requested information is for documents, some of it is for obituaries, but all infomation is kept confidentially.
FULL NAME*-
NICK NAME OR ALIASES*-
SOCIAL SECURITY NUMBER*-
MAILING ADDRESS*-
CITY,STATE, ZIP*-
TOWNSHIP, COUNTY*-
PHONE NUMBER*-
LENGTH OF TIME IN COMMUNITY-
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DATE OF BIRTH*-
BIRTHPLACE*-
NAME OF FATHER*-
CITY & STATE/DECEASED-
MAIDEN NAME OF MOTHER*-
CITY & STATE/DECEASED-
NATIONAL DECENT*-
RACE*-
U.S. CITIZEN*-
EDUCATION (HIGHEST COMPLETED GRADE)*-
SPECIFY SCHOOLS ATTENDED, YEARS AND IF GRADUATED-
OCCUPATION*-
YEARS IN OCCUPATION-
INDUSTRY*-
EMPLOYER-
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MILITARY SERVICE(Y/N)*-
SERVICE SERIAL NUMBER*-
RANK*-
DATE OF ENTRY*-
PLACE OF ENTRY*-
DATE OF DISCHARGE*-
PLACE OF DISCHARGE*-
BRANCH OF SERVICE*-
WAR*-
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MARITAL STATUS*-
MAIDEN NAME(s) OF SPOUSE(s)*-
DATE(s) OF MARRIAGE-
PLACE(s) OF MARRIAGE-
DATE(s) OF DEATH-
PLACE(s) OF DEATH-
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Within this section, list the names from oldest to youngest. Also include their city and state of residense or indicate if they are deceased. Also include the name of their spouse.
NAMES OF CHILDREN-
NAMES OF GRANDCHILDREN-
NAMES OF GREAT GRANDCHILDREN-
NAMES OF BROTHERS AND SISTERS-
PET(s)-
OTHER (DESIGNATE RELATIONSHIP(s))-
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LODGES, CLUBS, ASSOCIATIONS-
HOBBIES, INTERESTS-
MEMORIALS PREFFERED(Y/N)-
MEMORIALS SHOULD BE DIRECTED TO-
OTHER INFORMATION-
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PLACE OF SERVICE-
OFFICIANT-
MUSICIAN PREFERENCES-
MUSIC PREFERENCES-
NAMES OF CASKET BEARERS-
NAMES OF HONORARY BEARERS-
NAMES OF URN BEARERS-
OTHER PARTICIPANTS-
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PLACE OF VISITATION/GATHERING-
STRUCTURED EVENT (SPECIFY)-
MUSICIAN PREFERENCES-
MUSIC PREFERENCES-
MEMORY BOARDS/TABLES NEEDED-
OTHER-
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TYPE OF DISPOSITION*-
PLACE OF FINAL DISPOSITION*-
ADDRESS*-
CITY,STATE, ZIP*-
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NAME OF INFORMANT*-
SOCIAL SECURITY NUMBER*-
ADDRESS*-
CITY,STATE, ZIP*-
PHONE NUMBER*-
FUNDING PREFFERENCE*-
*Information required for documents and forms, those items not indicated are for obituary purposes.
