Obituary Online Form

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Your Email*

Phone Number*

What is the name of the conference you are apart of?*

Please fill in blanks and VERIFY all information.

Name of deceased

First Name*

Middle Initial

Nickname (optional)

Maiden Name

Last Name*

Date of Birth (mm/dd/yyyy)*

City of birth*

State of birth*

If you selected "other," please indicate country

Date of death*

Age at time of death*

Place of death

City of death*

State of death*

Name of Church*

City, State of Church*

SURVIVING family members:

Give each man’s given name, initial, and family name as he was known, and give each woman’s name and initial, (maiden name), and married name. Separate the family members’ names with commas.

DO NOT LIST DECEASED FAMILY MEMBERS.

The family member components listed below are the only family members we list due to space constraints. Aunts and uncles, nieces and nephews, and cousins are not listed. Also, space does not permit listing the city where each surviving member lives.

First name of spouse

Middle initial of spouse

"Nickname" of spouse

Maiden name of spouse if applicable

Last name of spouse

Son(s): First name (First name of spouse & maiden name if different) Last Name

Stepson(s): First name (First name of spouse & maiden name if different) Last Name

Daughter(s): First name, maiden name if used (First name of spouse) Last Name

Stepdaughter(s): First name, “maiden name if used” (First name of spouse) Last Name

Foster child(ren)

Father

Mother (include maiden name)

Brother(s)

Stepbrother(s)

Half brother(s)

Sister(s)

Stepsister(s)

Half sister(s)

Other relatives

Number of grandchildren

Number great-grandchildren

Number of step-grandchildren

Number of step-great-grandchildren

Number of great-great-grandchildren

Number of step-great-great-grandchildren

Preceded in Death

Please list deceased immediate family members only.

Preceded in death by (Example: his/her spouse, name)

Services

If yes, please provide URL or venue host

Date of service

If other, please explain

Please select one

Type of Service

Please select one of the following.

Internment *

Inurnment *

Name of cemetery (if interment was selected)

Name of facility (if inurnment was selected)

City

State*

If people would like to send a card of sympathy or a gift in memoriam, please enter information here:

Photo and extended obituary may be added online free of charge.

Accepted file types: jpg, jpeg, gif, png, ico, mp3, m4a, ogg, wav, avi, mpg, mov, mp4, m4v, ogv, wmv, 3gp, 3g2, pdf, doc, docx, ppt, pptx, xls, xlsx, xlsm, key, pages, numbers, odt, ods, dtp, txt, csv, Max. file size: 150 MB.

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Having trouble or got a question?

If you have a question or are experiencing trouble submitting this form, please contact Katie Fellows at katie.fellows@lakeunion.org.