KINDLY FILL UP THIS FOR THE FABRICATION OF STONE TABLET

NAME OF DECEASED ___________________________________________ ________

BORN ON ________________________________ ___________________
DIED ON ___________________________________ ________________
BONE REMAINS OF ________________ _______________ ____________________
FOOT NOTE ____________________________ ______________ _________
____________________________________________ _ _____
__________________________________________ _________
_____________________________________ ____ ___________

Printed Name : _______________________________ ________________

Signature : _______________________________ ________________
Date Signed : _______________________________ ________________
Time : _______________________________ ________________
Interment Date/ Time: _______________________________ ________________

KINDLY FILL UP THIS FOR THE FABRICATION OF STONE TABLET

NAME OF DECEASED ___________________________________________ ________

BORN ON ________________________________ ___________________
DIED ON ___________________________________ ________________
BONE REMAINS OF ________________ _______________ ____________________
FOOT NOTE ____________________________ ______________ _________
____________________________________________ _ _____
__________________________________________ _________
_____________________________________ ____ ___________

Printed Name : _______________________________ ________________

Signature : _______________________________ ________________
Date Signed : _______________________________ ________________
Time : _______________________________ ________________
Interment Date/ Time: _______________________________ ________________