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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Name of Deceased<br>''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Name of Deceased<br>''' | ||
| valign="middle" align="center" width="16%" | <br> | | valign="middle" align="center" width="16%" | <br> | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Date of Death''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Date of Death''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Place of Death''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Place of Death''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Date of Birth/Age''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Date of Birth/Age''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Place of Birth''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Place of Birth''' | ||
| valign="middle" align="center" width="16%" | '''<br>''' | | valign="middle" align="center" width="16%" | '''<br>''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Place of Burial''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Place of Burial''' | ||
| valign="middle" align="center" width="16%" | '''<br>''' | | valign="middle" align="center" width="16%" | '''<br>''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Parents' Names/Maiden''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Parents' Names/Maiden''' | ||
| valign="middle" align="center" width="16%" | '''<br>''' | | valign="middle" align="center" width="16%" | '''<br>''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Occupation of Deceased''' | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | '''Occupation of Deceased''' | ||
| valign="middle" align="center" width="16%" | '''<br>''' | | valign="middle" align="center" width="16%" | '''<br>''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
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| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | | ||
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| valign="middle" align="center" width="16%" | '''<br>''' | | valign="middle" align="center" width="16%" | '''<br>''' | ||
| valign="middle" align="center" width="16%" | '''<br> | | valign="middle" align="center" width="16%" | '''<br>''' | ||
|} | |} | ||