Obituary Worksheet Information

Full Name:

Date of Birth

Date of Passing

Father's First Name

Father's Last Name

Mother's First Name

Mother's Last Name

Spouse's Name (include maiden name for wife):

Marriage

Church/Lodge/Club Affiliations

Employment Information

Hobbies/Interests

Military Veteran?

Branch of Service

Other Military Information

Memorial Contributions To

Memorial Contributions in Lieu of Flowers?

Service Information (Date, Time, Location, Burial, Etc.)

Preceded in Death by

Free Text

Survivors (include spouses and city of residence, if desired)

Spouse

Children

# of Grandchildren

Names of Grandchildren (if listed by name in obituary)

# of Great-Grandchildren

Names of Great-Grandchildren (if listed by name in obituary)

# of Great-Great-Grandchildren

Names of Great-Great-Grandchildren (if listed by name in obituary)

Parents

Siblings

Several Nieces and Nephews

Other Survivors

Submitter

Relationship to Deceased

Phone Number