St. Vincent de Paul Parish

Los Angeles, CA

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memorial registration form

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  Deceased - Fallecido
  
  Frist Name - Primer Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name - Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Death - Fecha que falleció REQUIRED Please fill out this field. Please enter a date.
  
  Submitted by - Enviado por
  
  First Name/Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name - Apellido REQUIRED Please fill out this field. Please enter valid data.
  
  Phone # Telefonico REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Total:
  
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