0
edits
no edit summary
No edit summary |
No edit summary |
||
| Line 219: | Line 219: | ||
|- | |- | ||
| 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>''' | ||
|- | |- | ||
| 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>''' | ||
|- | |- | ||
| 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>''' | ||
|- | |- | ||
| 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>''' | ||
|- | |- | ||
| 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>''' | ||
|- | |- | ||
| 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>''' | ||
|- | |- | ||
| 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%" | | | valign="middle" align="center" width="16%" | | ||
|- | |- | ||
| 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>''' | ||
|- | |- | ||
| valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | | | valign="middle" align="center" width="52%" bgcolor="#99ccff" height="25" | | ||
| Line 254: | Line 254: | ||
| 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>''' | ||
|} | |} | ||