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Get IL Marin Funeral Home Death Certificate Worksheet

N NAME: 8) BIRTHPLACE: 9) SOCIAL SECURITY NUMBER: 10) MARITAL STATUS AT TIME OF DEATH: 11) SURVIVING SPOUSE’S NAME (If wife, give full name prior to first marriage): 12) EVER IN U.S. ARMED FORCES?: □ YES □ NO 13) HOME ADDRESS OF DECEASED: 14) CITY: INSIDE CITY LIMITS?: □ YES 15) COUNTY: 16) STATE: □ NO 17) ZIP CODE: 18) FATHER’S NAME (First, middle, last): 19) MOTHER’S NAME PRIOR TO FIRST MARRIAGE (First, middle, last): 20) INFORMANT’S NAME: 21) RELATIONSHIP TO DECEDENT.

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