When Borni.e.
10 May 1881
Where BornCounty,
City, ST
When Died i.e. 21
June 1920
Where DiedCounty,
City, ST
When Buriedi.e.
11September 1936
Where BuriedCemetery,
County,
City, ST
When Marriedi.e.
12 October 1913
Where MarriedCounty,
City, ST
Other Wives(ifany)Number(1)(2)(3), etc.
His Father
His Mother's Maiden Name
WIFE'S MAIDEN NAME
When Borni.e. 01
January 1900
Where BornCounty,
City, ST
When Diedi.e.
02 February 1902
Where DiedCounty, City, ST
When Buriedi.e. 10
March 1910
Where BuriedCemetery,
County,
City, ST
Other Husbands(ifany)Number(1)(2)(3),etc.
Her Father
Her Mother's Maiden Name
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Compiler_______________________
Address_________________________
City____________________
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