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*First Name Middle Name

*Last Name Suffix (Jr./Sr./IV/etc.)

*Birth Date *Death Date

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Survived by

Preceded in Death by

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Was the deceased interned in Colorado? Yes No

Cemetery

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Marker Type (select one) *

Headstone Tree Marker

Headstone On Base Ledger

Headstone In Base Statuary

Obelisk Column

Pedestal Monument Box Tomb

Flat Marker Bench

Cross Family Stone

Table Stone Other

Material (select one) *

Granite Slate

Marble Zinc (White Bronze)

Wood Metal

Sandstone Limestone

Other

Military Marker? Yes No

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