Obituary

Deceased Information

Name and Age of Deceased *

Residence of Deceased *

Place and Time of Death (Day, Date, Time) *

Services (check all that apply) *

Funeral

Graveside

Burial

Cremation

Funeral Date/Time

Funeral Location

Memorial Date/Time

Memorial Service Location

Who Officiated?

Organist

Soloist

Interment is Where

Vigil Services/Rosary Services:

Officiated by Whom?

About the Deceased:

Date and Place of Birth

Father's Name

Father Living or Deceased?

Mother's Maiden Name:

Mother Living or Deceased?

Name of Spouse (include maiden name, if applicable)

Spouse Living or Deceased?

When and Where Married?

Career Information: Give a BRIEF description of occupation, education, military or other special honors:

Other Survivors? Children's Names, Names of Spouses and Where They Live, if Applicable:

Brothers and Sisters (with spouses and where they live):

Number of Grandchildren

Number of Great-Grandchildren

Number of Great-Great-Grandchildren

Preceding in Death

Pallbearers:

Memorials May Be Made To:

Name of Funeral Home in Charge of Services:

Name and Phone Number of Person Who May be Contacted in Case More Information is Needed: *

Photo

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