Rochester Funeral Homes |
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Resource GuidePlanning Funeral Planning Check
List, Vital Statistics Form, Vital StatisticsThis information will be required to fill out the death certificate. You must be sure all information and spelling of names are correct. Death certificates currently cost $30.00 each and will be required for social security, insurance benefits, and other legal matters. Name _______________________________________ Social Security Number ________________________ Address _____________________________________ City ______________________________, State ____ County_________________, Country ______________ Birth Date ___/___/___, Birth Place ______________ Armed Forces Serial Number ____________________ Occupation___________________________________ Name/Address of Employer _____________________ ____________________________________________ Education 1-12 ______ College 1-4 or 5+ ______ Name of Father_______________________________ Name of Mother (Maiden) ______________________
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