Page 53 - 2024-04 Resource Guide
P. 53

Obituary Form, Cont.


        Survivors:


                     Name                          Relationship                Residence: City & State
        _____________________            _____________________           _____________________

        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________

        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________

        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________

        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________

        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________
        _____________________            _____________________           _____________________


        Preceded In Death By:  _________________________________________________

        ____________________________________________________________________
        ____________________________________________________________________
        ____________________________________________________________________
        ____________________________________________________________________

        ____________________________________________________________________

        Which Newspapers:  ___________________________________________________
        ____________________________________________________________________
        ____________________________________________________________________



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