Name:

Age:

Born in:

Residence town and years lived there:

Previous residence town:

Place of employment:

Number of years there:

Year of retirement:

Veteran/Branch/War/Medals:



Church membership:

Clubs or Organizations:



Other info (Hobbies, Passions, Life Events, Awards, Favorite Teams, Books, Movies etc.):





Memorial Donations to:



Survivors Names:

Parents:



Spouse:

Sons:





Daughters:





Brothers:





Sisters:





Grandchildren:





Great-grandchildren:





Nieces & Nephews: