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| North Carolina DIVISION ~ Deceased Members
Period September 1, 2009 until August 31, 2010 Please report deaths to Division Chaplain as they occur, but no later than September 5, 2010 District Number___________ Date: ____________________ Chapter Name __________________________________________________ Number __________________ City: _____________________________________ President: _________________________________ Phone: _______________ * Note: Please specify Real Daughter and/or Division or General Officer or Past Officer. List Office(s) held and years. ************************************************************************************** Full Married Name: ______________________________________________________________________ Husband's Name if applicable: ____________________________________________ __________________ Date of Birth: _______________________ Date of Death: _______________________ Contact name and address for sympathy card: Relationship:______________________ _______ _______________________________________________________________________________________ *************************************************************************************** Full Married Name: _______________________________________________________________________ Husband's Name if applicable: ____________________________________________ Date of Birth: _______________________ Date of Death: _______________________ Contact name and address for sympathy card: Relationship: _____________________ ________________________________________________________________________________________ *************************************************************************************** Full Married Name: _______________________________________________________________________ Husband's Name if applicable: ______________________________________________________________ Date of Birth: _______________________ Date of Death: _______________________ Contact name and address for sympathy card: Relationship: ____________________________ _______________________________________________________________________________________ Please report all deaths immediately so that they may be acknowledged and included in the Division Memorial Service. The Division Chaplain will report all deaths to the Chaplain General and the UDC Magazine. Please report deaths to the Division Chaplain as they occur, but no later than September 5, 2009. Send to: Division Chaplain, Jasey Barringer (Mrs. Tyson Wrenn) 6806 Blalock Road, Bahama, NC 27503 Email: laps17@yahoo.com TCH 2007, form may be copied |