Obituaries

Marilynne Lott
B: 1930-12-29
D: 2017-07-21
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Lott, Marilynne
Rosetta Brown
B: 1924-08-16
D: 2017-07-16
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Brown, Rosetta
Linda Evans
B: 1956-07-12
D: 2017-07-15
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Evans, Linda
Robert Perkins
B: 1934-06-26
D: 2017-07-12
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Perkins, Robert
Roberta York
B: 1924-10-06
D: 2017-07-12
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York, Roberta
Margie Cole
B: 1931-01-04
D: 2017-07-11
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Cole, Margie
Lee Carter
B: 1933-04-17
D: 2017-07-10
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Carter, Lee
Marjorie Hines
B: 1917-00-00
D: 2017-07-08
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Hines, Marjorie
Claudia Smith
B: 1927-11-05
D: 2017-07-07
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Smith, Claudia
Lucille Pryor
B: 1924-05-04
D: 2017-07-03
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Pryor, Lucille
Corrie Harris
B: 1910-11-18
D: 2017-07-01
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Harris, Corrie
Frederick Ford
B: 1965-09-21
D: 2017-06-30
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Ford, Frederick
Gwendolyn Johnson
B: 1952-07-04
D: 2017-06-24
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Johnson, Gwendolyn
John Hurt
B: 1932-10-01
D: 2017-06-22
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Hurt, John
Flora Williams
B: 1946-10-07
D: 2017-06-18
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Williams, Flora
Andrewen Brewer
B: 1975-06-25
D: 2017-06-16
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Brewer, Andrewen
Ethel Duncan
B: 1931-06-16
D: 2017-06-13
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Duncan, Ethel
Johnnie Greer
B: 1952-06-15
D: 2017-06-13
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Greer, Johnnie
Marsha Newberry-Jones
B: 1952-08-14
D: 2017-06-10
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Newberry-Jones, Marsha
Ricky Thomas
B: 1958-03-12
D: 2017-06-09
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Thomas, Ricky
Clyde Greggs
B: 1936-11-24
D: 2017-06-07
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Greggs, Clyde

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Phone: 626-798-8941
Fax: 626-798-0195

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I. Biographical Information
 
Full Name:
Date of Death:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded In Death
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

II. Military Record

Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences

Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

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Please place my information on file


 

 

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