Obituary Form | Gray's West & Co. Pioneer Chapel | Baker City, OR

Obituary Form

Date

S.S.#

Education

Name of Deceased

Age

Address

Date of Birth

Place of Birth

Date of Death

Place of Death

Father Name

Mother Name

Occupation

Church/Organisations

Veteran

Spouse (Maiden)

Preceded in Death by

Survivors: Son(s) Address

Daughter(s) Address

Brother(s) Address

Sister(s) Address

G-Kids

GG-Kids

GGG-Kids

Service Time

Date

Day

Place

Minister

Place of Burial

Visitation

Pallbearers

Additional Info

Death Certificates needed

Vault

Yes

No

Family Physician

Informant Name

Street Address

City

State

Zip Code

Informant Phone Number