Page 31 - Jones Family Funeral Homes
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                 Vital Statistics
The information below will be necessary for the preparation of a death certificate.
The funeral director will record it and have certified copies made. Date:............................................................................
My full name: ....................................................................................................................................................................
First Middle Last
Address:.............................................................................................................................................................................
City Province Country
Birthplace: .........................................................................................................................................................................
City Province Country
Birth date:.................................................................................... Social insurance number:......................................... Citizen of what country: ................................................................................................................................................... Schools attended: ....................................................................... From: .....................To: .................... Degree:............. ............................................................................................................................................................................................ ............................................................................................................................................................................................ Number of years of formal education: ............................................................................................................................
Professional statistics
Company:.................................................................................... Job title:..................From:...............To:..................... ............................................................................................................................................................................................ ............................................................................................................................................................................................ Professional achievements: ............................................................................................................................................. ............................................................................................................................................................................................ Years residence established in this province:........................... Years residence established in this community:..... Marital status: Married Single Divorced Widowed Common Law
Date of marriage: ........................................................................ Name of Partner:........................................................
Birthplace:................................................................................................................................Date: ............................... City Province Country
Name of father: .................................................................................................................................................................
Birthplace:................................................................................................................................Date: ............................... City Province Country
Mother’s maiden name:...................................................................................................................................................
Birthplace:................................................................................................................................Date: ............................... City Province Country
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