PFEFFER
KLEIN & STANGEL
CHRISTIANSON & DEJA
Your Locally Owned Community Funeral Homes & Cremation Care Centers
Name:
Address:
City:
State:
Zip:
Age:
Social Security No.:
Telephone No.:
Date of Birth:
Place of Birth:
Father:
Mother (Maiden Name)
Education:
Veteran:
Husband/Wife:
Date of Marriage:
Place of Marriage:
Spouse's Age or Date of Death:
Places of Residence:
Occupation:
Organizations:
Responsible Party:
Address:
Telephone #/e-mail address
Survivors:
