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Obituary Form

Mon, 09/26/2016 - 6:58am

Please submit form by Friday at 10am for inclusion in the publication. A photo, as desired, is also appropriate. The photo should be clear and well focused. Scanned Polaroids and photos printed on an inkjet printer are unacceptable.

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?

Living

Deceased

Mother's Maiden Name:

Mother Living or Deceased?

Living

Deceased

Name of Spouse (include maiden name, if applicable)

Spouse Living or Deceased?

Living

Deceased

If Spouse is Deceased, Date of Death

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

Please list name and relationship to deceased

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

Files must be less than 2 MB.
Allowed file types: gif jpg png.

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Obituary Form

Cobras take the field for the first time of the season

Jackson County Herald Tribune

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