DENGLER FUNERAL HOME RECORDS

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ADDRESS ___________________________________________________________

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EMAIL _______________________________________________________________

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The charge for the first copy is $5.00. Two to Five copies is $10.00. PA residents must include 6% sales tax. These charges include shipping.

Please send this form along with your check or money order made payble to BCGS to:

BCGS

P O Box 662

Butler, PA 16003