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Name of Deceased ___________________________________________
Date of Birth_________________Date of Death_____________________
Cemetery ____________________________________________________
Other (family farm, etc) ________________________________________
Circle One: Miller Co, AR or Bowie Co, TX
Location of burial place if known: _________________________________________________________________
_________________________________________________________________
Source (Copy of Death Cert., Obit, Family Story, Aunt Mary said, etc)
___________________________________________________________
Submitted by:
Name______________________________________________
City & State________________________________________
E-Mail_____________________________________________