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
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