Form: Obituary Form

Name and Age of Deceased

Residence of Deceased

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

Funeral Date/Time

Funeral Location

Memorial Date/Time

Memorial Service Location

Who Officiated?

Interment is Where:

Pallbearers:

Vigil Services/Rosary Services:

Date and Place of Birth

Father's Name

Mother's Maiden Name:

Name of Spouse (include maiden name, if applicable)

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

Photo

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:

First/Last Name

Phone Number

Billing Address / City / State / Zip