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

Patricia Anne Pierce

Thomas Fred Wing

William Raymond Wood

Patricia Jewell

Susan “Susie” Elaine Buterbaugh

Scott Lee Scribner

Claude Fredrick Bumpus Sr.

Michael Norman White

Allene M. Gantz

Glen W. Payne

Joseph “Joe”  Mahlon Chase

Joseph ‘Bernard’ Loftus