| * |
Your Name: |
e.g. Jim Jack Jones, Jr. |
| * |
Your Complete Email Address: |
e.g.: jdoe@japordomain.com |
| * |
County Died:
MO County with the information - County Death Certificate is Registered in. |
e.g. Barry Co. - Newton Co. |
| * |
Name of Barry County Cemetery: (Enter the word "Cremated" if
needed) |
e.g.: Washburn Prairie, Clio, Clark, Etc. |
Name of Deceased:
If a female with additional married names, place the additional marriage information in the note section at the bottom of this form. Do not list
unmarried females, males or children with maiden names. |
| * |
Surname: |
e.g. JONES |
| * |
Maiden Name:
If given - For married women only. Children, men or women who have never married do not have maiden names. |
e.g. SMITH |
| * |
Given Name: |
e.g. Mary |
Because of space limitation on the individual cemetery pages PLEASE abbreviate months to
the Sept., Jan. etc. format. See examples.
For places - if entering a county name - PLEASE abbreviate. See examples.
Thanks, this will save me a great deal of work. |
| * |
Date of Birth - if given |
e.g.: Jan. 1, 1900 |
| * |
Place of Birth - if given |
e.g. Near Purdy, Barry Co., MO |
| * |
Age at Death - if given |
e.g. 16 years, 2 months and 3 days. |
| * |
Date of Death |
e.g. Feb. 1, 1926 |
| * |
Place of Death |
e.g. Flat Creek Twp., Barry Co., MO |
| * |
Cause of Death - if given |
e.g. Accidental gun shot to the abdomen area. |
| * |
Father's Name & Where Born - if given |
e.g. Jim Bob Jones, born Neosho, MO |
| * |
Mother's Name & Where Born - if given |
e.g. Jane Smith, born Cassville, Barry Co., MO |
| * |
Spouse's Name & Where Born - if given |
e.g. Mary Jackson Smith, born Washburn, Barry Co., MO |
| * |
Occupation - if given |
e.g. farmer, worked for the railroad |
| * |
Served in the Military? |
e.g. Yes, No, N/A |
| * |
Informant & Address - if given |
e.g. Amelia Smith, Rt. 1, Cassville, MO |
| * |
Death Certificate Number |
e.g. #6464 |
| * |
Resource: |
e.g. Barry Co., MO, Death Certificates |
You may now enter additional information given such as the something the doctor may have reported or a place where the burial was if other than Barry County.
DO NOT ADD ANYTHING THAT IS NOT WRITTEN ON THE DOCUMENT.(Please be brief.)
DO NOT USE UPPER CASE WORDS FOR SURNAMES in the research note as text.
Example: Not HADDOCK - use Haddock. As in - Mary Haddock was a resident of Barry County.
A note at the bottom can explain when facts seem to be incorrect.
Example: Research Note: Bob's stone reads that he was born in 1896 not 1886 as the death certificate reads. His age at death that is given on the death certificate would make the 1886 date the correct one.
Add here below - Research Note: |
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