HUSBAND's name:
Born:
Died:
Burial:
Father:
Mother:
Other Spouses:
WIFE's name:
Born:
Died:
Burial:
Father:
Mother:
Other Spouses:
CHILDREN's names:
1. Name:
Born:
Married:
Died:
Burial:
Spouse:
2. Name:
Born:
Married:
Died:
Burial:
Spouse:
3. Name:
Born:
Married:
Died:
Burial:
Spouse:
4. Name:
Born:
Married:
Died:
Burial:
Spouse:
5. Name:
Born:
Married:
Died:
Burial:
Spouse:
6. Name:
Born:
Married:
Died:
Burial:
Spouse:
Please fill out the form above and send it to Hershell D. PORTER (PH. 399-9838), 129 MARGO DR, CHARLOTTE NC 28214-9542.