Georgia ClausenPage No.
Date of Death
Name
Place of Death - County City Hospital
Birthplace Date of Birth -------Age
Spouse's Maiden Name
Marital Status
V i �a,
Residence
Occupation
Mother's Maiden Name
Father's Name Autopsy
SocialSecurity Number Veteran
Physicia
CDate
Services l Day Tirne
Vocalist
Minister organist
Burial Date
Cemetery Location
urganizauonb
Pallbearers:
Husband or Wife
f I
Children:
Brothers and Sisters: