Obituary Questionnaire

The form below will help us create the obituary for the newspaper.

The cost of the newspaper obituary is based on the amount of information you wish printed. Any information you do NOT wish printed, do not place on this form.

This completed form and photo must be returned by 11:00 am to the funeral home 2 days prior to newspaper print.

Alternately, you can download this form as a pdf that you can edit and email back to us at [email protected] - click here to download the form.

NOTE: Many of the fields on this form are required. The required fields are marked with an asterisk ( * ). If you are unsure of the answer to a required field, or if it's not applicable - please enter "N/A" into the field.

Responsible Individual for Arrangements of the Deceased

Please provide the name and contact information of the person responsible for making the arrangements of the deceased.

Information about the Deceased

Please upload a photo of your loved one for the online obituary by clicking the Choose Files button below.

Allowed files: .jpg, .jpeg, .png, .pdf

Church or Religious Affiliations

In the field below, please list any clubs, ministries, boards, etc that the deceases was a member of in his/her church.

Education Information

In the field below, please list educational accomplishments of the deceased, giving name of school, city and state, and level completed - high school graduate, college graduate, trade school, etc.)

Employment History

Memberships & Interests

In the field below, please list any fraternal, professional memberships, civic, community activities, special interests, hobbies, etc.

Military Service

Survivors Listed in Obituary

Please list all living persons you wish to include in the newspaper obituary, relationship, city and state where the survivor resides.
Common examples are: Husband, wife, sons, daughters, sisters, brothers, mother, father, maternal grandparents, paternal grandparents, etc. Also list spouses if you wish those names to be included.

If there are more than 15 survivors you would like printed in the newspaper obituary, please add them in the field below. Please include their Name, Relationship, City and State.

If you wish to print the number of grandchildren, great-grandchildren, great-great grandchildren, or step-grandchildren, rather than give names, please provide the number in the fields below

Preceded Deceased in Death

If you wish printed in the newspaper who preceded the deceased in death, please provide their names and relationships in the fields below.

Viewing and Service Information

In the fields below, please enter the date, time, place and address of the viewing and/or services as previously discussed with your funeral director.

Important: Service dates and times must be confirmed with funeral director prior to any publication or sharing of service details.

Charitable Organizations

If you wish to have memorial gifts made in memory of person printed in newspaper, please give complete name, address, and zip code of the organization(s).

Additional Information

If there is any additional information you wish to have printed in the newspaper obituary, please enter that into the field below.

Your Information

Please provide your information below. In the event we have any questions, having your contact information will allow us to easily reach out to you.

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