Obituary Report Template printable pdf download

Obituary Report

RETURN FORM TO:

The Clearwater Progress

PO Box 428/417 Main Street

Kamiah, ID 83536

(208) 935-0838

Fax: (208) 935-0973

(Please type or print clearly)

Full name of deceased__________________________________________________________________________

Address______________________________________________________________________________________

Date of death___________________________ Date submitted_________________________________________

Cause of death (strongly recommended)___________________________________________________________

Place of death_________________________________________________________________________________

Occupation___________________________________ Occupation of spouse_____________________________

Place of birth________________________________________ Date of birth_________________ Age_________

Name of parents of deceased (include mother’s maiden name)________________________________________

_____________________________________________________________________________________________

Marital Record

Include each spouse’s name prior to marriage, date and place of marriage and date of divorces or death if applicable.

_____________________________________________________________________________________________

Residence and Work History

Include dates and locations.

_____________________________________________________________________________________________

Personal Information

Please list church affiliation and all positions, titles and memberships, including dates, in civic organizations,

public agencies, lodges, special activities, etc.

_____________________________________________________________________________________________

Education: List name of school, location and years attended or graduated:______________________________

_____________________________________________________________________________________________

Military service: Branch, years, duty stations, rank achieved and medals:________________________________

_____________________________________________________________________________________________

Obituary Report Template