Death Notice Word
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Death Notice For publication in the Modoc County Record (Recent photo encouraged) FULL NAME: Address: Birth Name: Date of Birth:Where: Date of Death:Where: Cause of death (optional): Marriage date:Where: Name of Spouse (or Wife s Maiden Name): Number of years in Modoc:Years gone from Modoc: Education (High School):Where: College:Where: Degrees Obtained:Armed Service Branch: War:Rank: Discharge Date: Occupation(s): Other noted skills, hobbies: Lodge-Club affiliations: Services Time and Date:Place: Clergy: Graveside Only Burial, where: Survivors: relationship and places of residence: D
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