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

Michael Russell Cox

Stephanie Sue Smith

Patricia Ann Fuller

Evelyn Edgerly Coulter

Marty Smoler

Gunar Gentry “G-Man” Reed

Warren Craig Maus

Charles Grant Heter

George Elliot Martz

Joyce Catherine Locke

Katrina Sue Bellem

Ellen Swansen