Page 15 - Joyner's Funeral Home & Crematory - NC
P. 15

Vital statistics about me:
Name given at birth:...................................................................................................................................................... Name for the obituary:.................................................................................................................................................. Address: .......................................................................................................................................................................... City: ................................................................................................................................................................................. State: ................................................................................................................... Zip Code:........................................... Social Security Number:............................................................................................................................................... Date of Birth:.....................................................................................................Gender:.............................................. County of Birth:................................................................................................State of Birth: .................................... Occupation: .................................................................................................................................................................... Number of Years of Education:.................................................................................................................................... Business/Industry:......................................................................................................................................................... Military Service:................................................................................................DD214 Included:.............................. Marital Status: ................................................................................................................................................................ Name of Spouse: ...................................................................Maiden Name of Spouse:............................................. Father’s Name (Given at Birth):................................................................................................................................... Mother’s Maiden Name (Given at Birth):...................................................................................................................
My preference for the location of the Visitation, Service or Celebration of Life:
Joyner’s Funeral Home Gravesite
Place of Worship
Address of Place of Worship ........................................................................................................................................
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