Obituaries

Bobby Henry
B: 1956-08-21
D: 2017-10-14
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Henry, Bobby
Terry Loehring
B: 1947-11-14
D: 2017-10-16
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Loehring, Terry
Ronald Spradling
B: 1948-11-17
D: 2017-10-17
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Spradling, Ronald
Marie Lyons
B: 1929-10-04
D: 2017-10-07
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Lyons, Marie
Geraldine Francis
B: 1924-04-27
D: 2017-10-02
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Francis, Geraldine
Robert Kern
B: 1928-08-14
D: 2017-08-08
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Kern, Robert
Thomas Martin
B: 1954-08-28
D: 2017-09-21
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Martin, Thomas
Alan Canterbury
B: 1932-10-04
D: 2017-09-16
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Canterbury, Alan
Janis Weston
B: 1931-01-06
D: 2017-09-13
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Weston, Janis
Stephanie Riley
B: 1966-12-21
D: 2017-09-12
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Riley, Stephanie
Dennis Blumberg
B: 1954-09-25
D: 2017-09-11
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Blumberg, Dennis
Vickie Thorsen
B: 1958-08-17
D: 2017-09-03
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Thorsen, Vickie
Jacqueline Skinner
B: 1927-06-26
D: 2017-09-01
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Skinner, Jacqueline
Robert Henry
B: 1953-07-10
D: 2017-08-28
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Henry, Robert
Marye Lion
B: 1933-11-11
D: 2017-08-31
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Lion, Marye
Paul Conant
B: 1957-04-14
D: 2017-08-19
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Conant, Paul
Kevin Spradling
B: 1955-10-06
D: 2017-08-23
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Spradling, Kevin
Marie Harvey
B: 1955-07-21
D: 2017-08-16
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Harvey, Marie
David Runner
B: 1936-10-01
D: 2017-08-12
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Runner, David
David Popp
B: 1961-04-01
D: 2017-07-23
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Popp, David
Constance Blamy
B: 1942-08-02
D: 2017-07-25
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Blamy, Constance

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O'Fallon, IL 62269
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Fax: 618-632-3732

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I. Biographical Information
 
Full Name:
Date of Death:
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 In Death
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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