Obituaries

Ruby Duch
B: 1933-05-29
D: 2017-06-12
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Duch, Ruby
Arthur Mackey
B: 1947-11-05
D: 2017-06-08
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Mackey, Arthur
Timothy Liupakka
B: 1967-07-25
D: 2017-05-30
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Liupakka, Timothy
Doris Wells
B: 1937-02-21
D: 2017-05-29
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Wells, Doris
Doris Wells
B: 1937-02-21
D: 2017-05-29
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Wells, Doris
Eugene Garand
B: 1943-03-03
D: 2017-05-29
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Garand, Eugene
Anthony Loria
B: 1922-08-19
D: 2017-05-22
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Loria, Anthony
Jaimie Foley
B: 1989-01-10
D: 2017-05-16
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Foley, Jaimie
Joe Lowe
B: 1934-11-14
D: 2017-05-13
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Lowe, Joe
Catherine Gilbert
B: 1931-04-13
D: 2017-05-11
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Gilbert, Catherine
Joseph Cahill
B: 1926-10-13
D: 2017-05-05
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Cahill, Joseph
Thomas Yates
B: 1957-02-11
D: 2017-04-26
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Yates, Thomas
Anthony Mirabel
B: 1972-04-14
D: 2017-04-26
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Mirabel, Anthony
Anthony Mirabel
B: 1972-04-14
D: 2017-04-26
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Mirabel, Anthony
Harry Shaffer
B: 1923-06-04
D: 2017-04-25
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Shaffer, Harry
Diana Roett
B: 1922-09-27
D: 2017-04-15
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Roett, Diana
Miriam Thiems
B: 1924-05-31
D: 2017-04-14
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Thiems, Miriam
Ronald Bright
B: 1931-12-16
D: 2017-04-14
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Bright, Ronald
Thomas Bragers
B: 1951-10-04
D: 2017-04-13
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Bragers, Thomas
Elizabeth DeLanoy
B: 1925-04-04
D: 2017-04-12
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DeLanoy, Elizabeth
Daniel Kearns
B: 1956-08-27
D: 2017-04-10
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Kearns, Daniel

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Phone: (386) 253-7601
Fax: (386) 253-7647

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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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