Fillable Printable The Reporter Obituary form
Fillable Printable The Reporter Obituary form
![The Reporter Obituary form](/resources/formfile/images/fb/source_images/the-reporter-obituary-form-d1.png)
The Reporter Obituary form
![](/resources/formfile/htmls/fb/the-reporter-obituary-form/bg1.png)
The Reporter Obituary form
Please print or type and be sure to fill out both pages of the form (if applicable).
Attach a separate page if necessary for any additional information.
Mortuary: ________________________________________________________________________________
Date submitted: ___/___/___ Preferred run date: ___/___/___
Name of deceased: Mr., Mrs., Ms. ____________________________________________________________
Nickname (optional): _______________ Date of birth: ___/___/___ Age: _______
City of residence: __________________________________________________________________________
Birth place: _______________________________________________________
Date & place of death: (Date) ___/___/___ (Place) BBBB____________________________________________
Services
Type of service:
other_____________________________________________________________________________________
Interment:
other _____________________________________________________________________________________
Date of Service: _____/_____/_____ Time of Service: _________________
Location: _________________________________________________________________________________
Clergy officiating: __________________________________________________________________________
Visitation date: _____/_____/_____ Time of Visitation: ________________
Visitation location: _________________________________________________________________________
Other services (time) _____________
Location _________________________________________________________________________________
Contributions preferred to: _________________________________________________________________
_________________________________________________________________________________________
Personal background
Cause of death (specific if you wish, or “long” or “brief” illness, accident, etc.)
_________________________________________________________________________________________
Occupation (s) (if more than one, list separately) Number of years Year retired
________________________________________ ______________ ___________
________________________________________ ______________ ___________
________________________________________ ______________ ___________
Special interests, organizations, church membership, hobbies, etc. (attach separate page if needed)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
![](/resources/formfile/htmls/fb/the-reporter-obituary-form/bg2.png)
Survivor Information
Please include names, cities of residence and whether predeceased
Spouse _____________________________________________________No. years married ______________
Parent(s) ________________________________________________________________________________
Brother(s)-in-law _________________________________________________________________________
Sister(s)-in-law ___________________________________________________________________________
Daughter(s)-in-law _______________________________________________________________________
Son(s)-in-law_____________________________________________________________________________
Stepbrother(s) ____________________________________________________________________________
Stepsister(s) ______________________________________________________________________________
Stepdaughter(s)___________________________________________________________________________
Stepson(s) _______________________________________________________________________________
Grandparent(s) ___________________________________________________________________________
Great-grandparent(s) _____________________________________________________________________
No. grandchildren ______ No. great-grandchildren ______ No. great-great-grandchildren _______
Grandchildren ___________________________________________________________________________
_________________________________________________________________________________________
Great-grandchildren ______________________________________________________________________
Great-great-grandchildren _________________________________________________________________
Other (long-time friend, companion, etc.) _____________________________________________________
_________________________________________________________________________________________
Must be completed & in to The Reporter by 1 p.m the day before publication
(for Sunday/Monday runs, by Friday 1 p.m.)
___________________________________________________________________
Phone (707) 453-8184: Fax (707) 451-5211: e-mail obits to [email protected]
Length ___________ Cost _______________ Date(s) of Publication _________________________________
What rate (circle) : WEEK DAY or WEEKEND and EMAILED or TYPED Costs of emblem(s) _______________
Cost for photo(s) ____________ 2nd day (35% off) ___________ additional days (1/2 price) ____________
Total cost _________________ Billing info. _____________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________