Obituary Submission (Simple Choices)

Contact Info (For Person Completing this Form)

Your Name*:

Your Telephone Number*:

Your Email*:

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Deceased*:

City/Township (of)*:

Formerly of (city/town):

Age:

Place of Death:

Date of Death :

Date of Birth:

Place of Birth:

Father's Name:

Mother's Name:

Places Raised/ Lived/Resided:

Education:

Employment History:

Military Career (Veteran):

Memberships/Clubs/Organizations:

Important Personal Information (such as achievements, personal traits, qualities, interests, etc.):

Spouse's Name:

Date of Marriage:

Place of Marriage:

Children [ from oldest to youngest] | if married include spouse (in parentheses) :

Grandchildren [oldest to youngest / or specify number of]:

Great grandchildren [oldest to youngest / or specify number of]:

Siblings [from oldest to youngest] | if married include spouse (in parentheses):

Predeceased by:

Calling Hours:

Service:

Burial:

Special Thanks | Acknowledgements To:

In Lieu of Flowers, Memorial Contributions To:

Please Specify Desired Newspapers (for print publication):

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Contact Information for the Person completing this Form.