Obituaries

Gloria Engelking
B: 1930-02-27
D: 2017-07-18
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Engelking, Gloria
Mary Katherine Gain
B: 1929-12-06
D: 2017-07-14
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Gain, Mary Katherine
Walter Witzke
B: 1946-09-07
D: 2017-07-12
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Witzke, Walter
James Barchman
B: 1973-10-19
D: 2017-07-11
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Barchman, James
Frances Keck
B: 1921-12-13
D: 2017-07-10
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Keck, Frances
Helen Stencil
B: 1913-09-30
D: 2017-07-06
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Stencil, Helen
James Smith
B: 1940-05-17
D: 2017-07-01
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Smith, James
Mary Wisniewski
B: 1934-09-10
D: 2017-06-28
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Wisniewski, Mary
James Brennan
B: 1941-12-15
D: 2017-06-26
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Brennan, James
Stella Stanich
B: 1922-03-21
D: 2017-06-24
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Stanich, Stella
Terry Kollar
B: 1950-03-13
D: 2017-06-15
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Kollar, Terry
Ann Wisniewski
B: 1922-11-20
D: 2017-06-09
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Wisniewski, Ann
Jean Herbst
B: 1922-02-19
D: 2017-06-08
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Herbst, Jean
Thomas Mann
B: 1957-02-23
D: 2017-06-06
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Mann, Thomas
Anthony Furlan
B: 1965-09-30
D: 2017-05-24
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Furlan, Anthony
Ellen Zyle
B: 1958-09-09
D: 2017-05-20
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Zyle, Ellen
John Kendzierski
B: 1935-07-14
D: 2017-05-16
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Kendzierski, John
Ned Stewart
B: 1957-10-21
D: 2017-05-14
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Stewart, Ned
Michael Rummel
B: 1971-07-26
D: 2017-05-11
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Rummel, Michael
Zita McCartney
B: 1920-03-01
D: 2017-05-11
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McCartney, Zita
Elaine Yanko
B: 1937-07-15
D: 2017-05-07
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Yanko, Elaine

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I. Biographical Information

Full Name:
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 You In Death
Your 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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Please place my information on file

         
       

 

 

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