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Planning and Death Certificate Information

The following information is required for submssion of the death certificate and will also be used for preparation of the service program and newspaper obituary. This information will be treated very confidentially and will not be used in any way except for carrying out the family wishes for funeral services. You may elect to:

  1. Fill out the form, print it, Email, fax or bring it in to the office
  2. Print a blank form, fill it out and mail, fax or bring it in to the office
  3. Bring the information into the office for us to fill out the form
Individual Information
Name
Date of Death Time of Death
Place of Death
Doctor
Residence
Age Birthday
Place of Birth
Race Marital
Status
Hispanic Type
Social
Security #
Degree of
Education
Occupation
Industry
Father's
Name
Mother's
Name
Informant Information
Name
Address
Relationship
Home Phone Cell Phone

Funeral Service Information
Clergy
Place of
Service
Interment
Clothing
Hair
Vets Rites By

Marriage Information
Spouse

Maiden Name
Place of
Marriage
Date of
Marriage
Date of
Spouse's
Death

Previous
Spouses'


Military Information
Branch of
Service
War Served
In
Date Of
Entry
Date of
Discharge
Rank Service
Number

Interests
Hobbies
Church
Activities
Clubs

Family Information
Children - Name, City & State Living
Brothers & Sisters & Where Living
Number of
Grandchildren
Number of
Great-Grandchildren
Grand Parents
Preceeded In
Death By
Number of Death Certificates Wanted
(First one $13.00, each additional $8.00)

       

 

In Memoriam In Memoriam
Search Archives
A B C D E F G H I J K L M N O P R S T U V W Y Z

Kevin Swoffer
b: 8/6/1979
d: 4/22/2018
Service: #
Pending

Ruth Johnson Keller
b: 2/7/1929
d: 4/16/2018
Service: 04/21/2018, 1:00 pm
Myers Mortuary Brigham City

Adonijah Foster
b: 1/18/2016
d: 4/14/2018
Service: 04/22/2018, 11:00 am
Rockland Ranch

Patricia Vidiella
b: 1/21/1963
d: 4/13/2018
Service: #
Private

Frank Corcione
b: 6/16/1953
d: 4/12/2018
Service: #
Private

Barbara Louthan Smith
b: 7/13/1939
d: 4/11/2018
Service: 04/21/2018, 12:00 pm
Spanish Valley Mortuary

Wayne Greer
b: 12/11/1931
d: 4/6/2018
Service: #
Private

David Baker
b: 11/3/1924
d: 4/5/2018
Service: 04/14/2018, 11:00 am
St Francis Episcopal Church

Todd Shannon
b: 1/8/1972
d: 4/5/2018
Service: 04/14/2018, 4:00 pm
Spanish Valley Mortuary

Neil Sutherland
b: 2/21/1968
d: 4/5/2018
Service: 05/18/2018, 1:00 pm
Castle Valley Cemetery

Normandy Rogers
b: 12/18/1982
d: 4/4/2018
Service: #
Private

Samuel Swindle
b: 2/21/1948
d: 4/3/2018
Service: #
Private

Brenda Stocks
b: 12/10/1939
d: 4/3/2018
Service: #
Private



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