DEATH OF A PERMANENT EMPLOYEE,
SPOUSE OR CHILD OF PERMANENT EMPLOYEE
Name of the deceased____________________________________________
Date of death___________________________________________________
Relationship to employee (spouse, child)_______________________________
Name of employee________________________________________________
School or office where employee works________________________________
Position held____________________________________________________
Employee’s mailing address________________________________________
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DEATH OF A STUDENT
Name of the deceased____________________________________________
Date of death___________________________________________________
School where student is enrolled_____________________________________
Parents’ name__________________________________________________
Parents’ home mailing address______________________________________