Death Notice

    Name of person providing information:

    Your email address:

    Relationship to deceased

    Daytime phone

    Full name of deceased


    City, State

    Date of death (yyyy-mm-dd)

    Date of birth (yyyy-mm-dd)

    Parents names Survive YesNo

    Date and place of marriage

    Spouse’s maiden name, if applicable Survive YesNo

    If yes, where?

    If no, give date of death, if known

    Other survivors, list by relationship/give town of residence

    Names of any deceased children of the descendant

    Biographical information for deceased

    Service information, including place of burial and officiating clergy

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