Page 48 - Partner Plus Media
P. 48

Personal Information
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:.....................................................................................................................................................................
Address: ..............................................................................................................................................................................
City Province Country
Birthplace: ..........................................................................................................................................................................
City Province Country
Birth date: ...................................................................................Social insurance number: .................................... Citizen of what country(s):.......................................................................................................................................... Schools attended: ....................................................................From:.....................To:.................... Degree: ........... ................................................................................................................................................................................................ ................................................................................................................................................................................................
Years residence established in Ontario: ................................................................................................................. Years residence established in this community: .................................................................................................
Marital status: Married Single Divorced Widowed Common Law Partner
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
PROFESSIONAL STATISTICS
Company:....................................................................................Job title:...............From:..............To:..................... ................................................................................................................................................................................................ ................................................................................................................................................................................................ Professional achievements:......................................................................................................................................... ................................................................................................................................................................................................
First Middle Last
              ~ 46 ~
  














































































   46   47   48   49   50