Vital Statistics Form

Please fill this form out as much as possible. It will help us to complete the death certificate and in writing the obituary. All fields with an asterisk are required.

Deceased's Information

If residence, please include address
mm/dd/yyyy
English, Irish, French, German, etc.
Be specific
Primary occupation during working years. *Do not enter \"retired\".
Sales, Medical, Engineering, Construction, etc.
Please list survivors and relationship: son, daughter, brother, sister, etc.
Religious affiliations, fraternal and civic organizations, hobbies, etc.

Informant's Information

A copy of what is submitted will be sent to this email.
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Obituaries & Condolences

Rudolph Hiram, Broadnax, Jr. (Lil Rudy)

Dr. Thomas Magstadt

Jill Earnestine Sherman

Mark Douglas Clardy

Jeffrey Mark Curtis

Wilma Dean Oxley

Kelly McMasters

Doris Crawford

Mark Bretches

Barbara Louise Copps Oliver

Michael John Onderko

Betty Jean Cockburn (Osborn)