Sample Obituary Template

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P.O Box 271
BUTLER, PA 16003
Fax# 724-282-4180
Telephone 724-282-8000
Email: • Web page
OBITUARY FORM
Name
Address
Formerly of
Date of death
Place of death
Cause of death
Date of birth
Place of birth
Father
Mother (include maiden name)
Name of spouse (include maiden name)
Marriage date
Place of marriage
If deceased, date
Additional spouse
Marriage date
Date of death
Education: Provide name, location of school, year graduated, degree received.
Employment history: Provide name, and location of firm, position held, year of
retirement or years of service
Church and location
Other memberships
Hobbies/interests
OBITUARY FORM

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