8,713
edits
| Line 35: | Line 35: | ||
| *Occupation and/or name of employer | *Occupation and/or name of employer | ||
| *Residence of the deceased | *Residence of the deceased | ||
| * | *Religious Affiliation | ||
| *Signature of attending physician | *Signature of attending physician | ||
| *Whether single, married, widowed or divorced | *Whether single, married, widowed or divorced | ||
edits