Obituaries

Willard Evans
B: 1943-12-28
D: 2018-04-18
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Evans, Willard
Hayden Gaskill
B: 2018-04-14
D: 2018-04-14
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Gaskill, Hayden
Marga Hayward
B: 1922-09-15
D: 2018-04-11
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Hayward, Marga
Joyce Eversman
B: 1937-05-19
D: 2018-04-09
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Eversman, Joyce
Jay McDaniel
B: 1958-04-04
D: 2018-04-09
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McDaniel, Jay
Jason Schmidt
B: 1984-12-18
D: 2018-04-03
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Schmidt, Jason
Audrey Melby
B: 1929-04-18
D: 2018-03-29
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Melby, Audrey
Carole Owings
B: 1943-05-28
D: 2018-03-22
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Owings, Carole
Stephen Gartland
B: 1959-11-04
D: 2018-03-21
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Gartland, Stephen
Marcia Latkovich
B: 1947-12-06
D: 2018-03-11
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Latkovich, Marcia
Dorothy Campbell
B: 1931-04-05
D: 2018-03-11
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Campbell, Dorothy
Mary Lugge
B: 1927-07-29
D: 2018-03-08
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Lugge, Mary
Orville Lester
B: 1938-10-08
D: 2018-03-07
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Lester, Orville
Elham Misiak
B: 1955-01-27
D: 2018-03-05
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Misiak, Elham
Carolyn Mahlman
B: 1948-06-20
D: 2018-02-28
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Mahlman, Carolyn
Barbara Brown
B: 1945-06-18
D: 2018-02-24
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Brown, Barbara
Betty Carroll
B: 1934-04-26
D: 2018-02-25
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Carroll, Betty
Lorraine Gelatka
B: 1921-08-22
D: 2018-02-25
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Gelatka, Lorraine
Robert Grimm
B: 1921-11-13
D: 2018-02-12
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Grimm, Robert
Jeffrey Warfield
B: 1953-10-04
D: 2018-02-10
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Warfield, Jeffrey
Karen Jerashen
B: 1941-07-11
D: 2018-02-08
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Jerashen, Karen

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O'Fallon, IL 62269
Phone: 618-632-3713
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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