Vital Statistics - Hilgenfeld Mortuary

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Full Name*

Email*

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Relationship to Decedent

Name

Aka, Also Known As-- include full AKA

Date Of Birth mm/dd/ccyy

Sex

Birth State/ Foreign Country

Ever In US Armed Forces?

Yes

UNK

Marital Status (At Time Of Death)

Date Of Death mm/dd/ccyy

Hour (24 Hours)

Education (Highest Level/Degree)

Was Decedent Spanish/Hispanic/Latino?

Yes

Decedent's Race (Up To 3 Races May Be Listed)

Usual Occupation - Type Of Work For Most Of Life

Kind Of Business Or Industry (e.g..grocery store, road construction, employment agency, etc.)

Years Of Occupation

Decedent's Residence (Street and number or location)

City

Country/Province

Zip Code

Years In County

State/Foreign Country

Name Of Surviving Spouse

First Name Middle Name Last Name

Name Of Father

First Name Middle Name Last Name

Birth State

Name Of Mother

First Name Middle Name Last Name (Maiden Name)

Birth State

Place Of Final Disposition

Comments

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