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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

       

Recent Obituaries

See our Facebook page for videos of recent funerals.


Patsy Phillips
b: 01/09/1947
d: 12/18/2024
Service: Pending


Kenneth Dungan Jr
b: 02/08/1954
d: 12/16/2024
Service: Private


James Nash
b: 08/07/1957
d: 12/09/2024
Service: 12/14/2024, 11:00 am St Francis Episcopal Church


Gordon Butcher
b: 08/20/1946
d: 12/08/2024
Service: At a later date


Dale Rosier
b: 09/10/1943
d: 12/02/2024
Service: Private


Sterling Wade
b: 02/12/1957
d: 11/26/2024
Service: Pending


Edward Pop Tangren
b: 01/26/1934
d: 11/24/2024
Service: 12/07/2024, 11:00 am Spanish Valley Mortuary