HTML Preview News Paper Funeral Notice Pdf page number 1.
Name:
WIEDERSPAHN-RADOMSKY CHAPEL
NEWSPAPER FUNERAL NOTICE
Male Age:
Residence:
City: State: Zip:
Date of Birth:
Place of Birth:
City: State: Zip:
Date of Death:
Place of Death:
City: State: Zip:
Marital Status: Married
Female
Married/Seperated Widowed Divorced
Never Married Unknown
Hispanic Origin: Not Spanish/Hispanic/Latino Mexican, Mexican/American, Chicano
CubanPuerto Rican Spanish, Hispanic, Latino
Race: White Black/African American American Indian/Alaska Native
Asian Indian Chinese Filipino Japanese Korean Vietnamese
Other Asian (specify): Native Hawaiian Guamanian/Chamorro
Samoan Other Pacific Islander Other (specify):
Veteran: Yes No
War(s):
Education: 8th< 9th-12th (no diploma) High School/GED Some College/No Degree
Associates Bachelor's Master's Doctorate/Professional Degree
Branch: Army Army National GuardAir Force Air National Guard
Coast Guard Marines Navy Other:
Occupation: Employer: Length:
Length of Residence Here: Prior Residence:
Church Affiliation:
Social Security Number:
Clubs/Organizations:
Husband or Wife: Wife's Maiden Name:
Sons:
Daughters:
Mother: Mother's Maiden Name:
Father:
Grandparents:
Brothers:
Sisters:
Number of Grandchildren: Number of Great-Grandchildren: