Obituary Forms

Obituary Form

Deceased Information

Name of deceased:

Sex:

 Female     Male

Age:

Maiden name (if married):

Place of death 
(home/name of hospital/other):

Date of death:

Long/short illness:

Place of residence 
(specific community/town/city):

Dates of residence in the 
Buffalo or surrounding area:

Date deceased left the area (if applicable):

Birthplace (city/state):

Spouse:

Date of spouse’s death
(if applicable):

Occupation:

Name of Firm:

Job Title:

Dates of employment:

Date of retirement (if applicable):

Education (0-12):

College 1-5+:

Branch of Service:

Serial Number:

Date Enlisted:

Rank At Discharge:

Date Discharged:

Discharge On File At:

Religious affiliations: 
 

Clubs, organizations, memberships, hobbies: 
 

Honors/awards:

  Survivors

(The newspaper will only use names of the immediate family as listed below. The city or town and state of the survivors must be included)

Daughters: 
 

Sons: 
 

Parents: 
 

Sisters: 
 

Brothers: 
 

Grandparents: 

Number of grandchildren:

Great-grandchildren:


  Funeral Service Information
 

Time of Service: