Fillable Printable The Reporter Obituary form
Fillable Printable The Reporter Obituary form
The Reporter Obituary form
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)
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
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. _____________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
