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?

Organist

Soloist

Interment is Where

Vigil Services/Rosary Services:

Officiated by Whom?

Date and Place of Birth

Father's Name

Mother's Maiden Name

Name of Spouse (include maiden name, if applicable)

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

Send a copy to the e-mail address