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*Date and place of burial | *Date and place of burial | ||
*Military service such as dates served and unit | *Military service such as dates served and unit | ||
*Name, address, and relationship of informant| style="vertical-align:top"| | *Name, address, and relationship of informant | ||
| style="vertical-align:top"| | |||
*Name of funeral home | *Name of funeral home | ||
*Time of death | *Time of death | ||