Personal Infomation Print

The following Information is required by the Department of Births, Deaths & Marriages. This informaton will help you in arranging the funeral.

Individual First Marriage

Surname: ______________________________

Age at Date of Marriage:______

Given Names: _______________________________

Place of Marriage: ____________________

___________________________________

Male/Female: ______________

Full Maiden Name of

Spouse:_____________________________

Usual Occupation (if retired former occupation):

 

 

Date of Birth:____/______/_______

Second Marriage

Place of Birth: (Town, State & Country/Year of arrival)

_____________________________________________

 

Age at Date of Marriage: _____

Married/Widow/Widower/Divorced/Never Married: ___________

Place of Marriage: ______________________

____________________________________

Usual Residence: ___________________________________

_________________________________________________

Full Maiden Name of Spouse:

____________________________________

 

Father’s Surname: __________________________________

 

Given Names: _____________________________________

 

Mother’s Maiden Name: _____________________________

 

Given Names : ____________________________________

 
   
Children (if deceased, please indicate)

1.

Given Names:

 

Date of Birth:

2.

Given Names:

 

Date of Birth:

3.

Given Names:

 

Date of Birth:

4.

Given Names:

 

Date of Birth: