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


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)


Given Names:


Date of Birth:


Given Names:


Date of Birth:


Given Names:


Date of Birth:


Given Names:


Date of Birth: