Obituaries

Genevieve Stark
B: 1938-03-28
D: 2017-08-14
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Stark, Genevieve
Keith Patrick Shinkle
B: 1991-10-23
D: 2017-08-14
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Shinkle, Keith Patrick
Robert Barbro
B: 1971-08-10
D: 2017-08-13
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Barbro, Robert
Dennis Johnson
B: 1953-02-23
D: 2017-08-13
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Johnson, Dennis
Ava Hope Hutchinson
B: 2017-08-12
D: 2017-08-12
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Hutchinson, Ava Hope
John Saner
B: 1924-02-28
D: 2017-08-12
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Saner, John
Jerry Grove
B: 1936-10-16
D: 2017-08-11
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Grove, Jerry
Leo Sunderman
B: 1925-06-09
D: 2017-08-10
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Sunderman, Leo
Elizabeth Srode
B: 1941-09-27
D: 2017-08-10
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Srode, Elizabeth
Joseph Benz
B: 1959-05-25
D: 2017-08-07
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Benz, Joseph
Mary Rizzo
B: 1922-08-14
D: 2017-08-05
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Rizzo, Mary
Joyce Pyles
B: 1938-02-11
D: 2017-08-04
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Pyles, Joyce
Sharon Fisher
B: 1942-04-02
D: 2017-08-03
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Fisher, Sharon
Carl Quinn
B: 1926-08-02
D: 2017-08-03
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Quinn, Carl
Dorothy Blades
B: 1922-07-10
D: 2017-08-03
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Blades, Dorothy
Lucille Kibler
B: 1924-06-16
D: 2017-08-03
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Kibler, Lucille
Donald Elliott
B: 1931-09-03
D: 2017-08-03
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Elliott, Donald
John Dos
B: 1985-02-25
D: 2017-08-01
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Dos, John
Dale Derbyshire
B: 1928-03-28
D: 2017-07-30
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Derbyshire, Dale
Shirley Tate
B: 1928-08-25
D: 2017-07-29
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Tate, Shirley
Antonetta "Toni" Richardson
B: 1944-07-17
D: 2017-07-29
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Richardson, Antonetta "Toni"

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I. Biographical Information
 
Full Name:
Date of Death:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded In Death
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

II. Military Record

Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences

Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

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