3801 4th Avenue
| Beaver Falls, PA 15010
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Tel: 1-724-843-1200
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Information About the Person Completing This Form

Deceased Vital Statistics for Death Certificate

Veteran Information

Informant/Person In Charge Information

For Cremation Only                 Legal next of kin must sign authorization for cremation. Legal authority as follows.

IF no spouse list the following next of kin

local_florist
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