Obituaries

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
Raymond O'Connor
B: 1932-09-11
D: 2017-08-01
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O'Connor, Raymond
Constance Blamy
B: 1942-08-02
D: 2017-07-25
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Blamy, Constance
David Popp
B: 1961-04-01
D: 2017-07-23
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Popp, David
Kathleen Mullen
B: 1942-09-21
D: 2017-07-12
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Mullen, Kathleen
Muriel Patricia Brock
B: 1931-06-25
D: 2017-07-10
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Brock, Muriel Patricia
Thomas Bagley
B: 1932-12-20
D: 2017-07-07
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Bagley, Thomas
Henrietta Bossler
B: 1924-01-19
D: 2017-07-05
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Bossler, Henrietta
Norman Reeves
B: 1940-03-25
D: 2017-06-29
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Reeves, Norman
James Cobb
B: 1936-10-25
D: 2017-06-06
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Cobb, James
Donald Bjornson
B: 1931-12-13
D: 2017-06-03
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Bjornson, Donald
Lucille Schneider
B: 1928-08-22
D: 2017-06-01
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Schneider, Lucille
Sharon Ganger
B: 1937-10-18
D: 2017-05-30
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Ganger, Sharon
Lucille Gross
B: 1921-10-24
D: 2017-05-23
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Gross, Lucille
Dennis Myracle
B: 1949-10-11
D: 2017-05-19
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Myracle, Dennis
Dane McGinthy
B: 1985-01-21
D: 2017-05-14
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McGinthy, Dane
Melissa Distler
B: 1986-01-01
D: 2017-05-05
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Distler, Melissa
Joseph Valtos
B: 1949-03-06
D: 2017-04-18
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Valtos, Joseph
Parker Kious
B: 1932-07-24
D: 2017-03-31
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Kious, Parker
Randel Lewis
B: 1949-07-20
D: 2017-03-31
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Lewis, Randel

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O'Fallon, IL 62269
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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:

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