Survivors (cont

Survivors (cont.): _______________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Date of Service__________________________________________ Time: ___________ Place of Service___________________________________________________________ Person Officiating the Service_______________________________________________ Viewing Times___________________________________________________________ Place of Viewings_________________________________________________________ ________________________________________________________________________ Cemetery________________________________________________________________

BROWN FAMILY MORTUARY 66 South 300 East Santaquin, Utah 84655 801-754-3692 / 801-754-1225 (fax) [email protected] (email) www.brownfamilymortuary.com

Obituary and Statistical Information

Family Phone____________________________________________________________

Name of Deceased____________________________________________ Age ________

Informant's Name _______________________________ Relationship_______________

Address_________________________________________________________________

Informant's Address_______________________________________________________

Date of Death_________________________________ Time of Death_______________

City___________________________ State _________________ Zip _______________

Place of Death____________________________________________________________

Phone ______________________email: ______________________________________

Cause of Death___________________________________________________________

Obituary to Run in Which Newspapers________________________________________

Place of Birth____________________________________________________________

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Date of Birth_____________________________________________________________

Social Security Number ____________________________________________________

(Accomplishments & Activities cont.)

1st Marriage: Full Name___________________________________________________

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Date of Marriage______________________________________________

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Place of Marriage_____________________________________________

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2nd Marriage: Full Name___________________________________________________

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(if applicable) Date of Marriage______________________________________________

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Place of Marriage_____________________________________________

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Is Spouse Still Living?_________ If No, Date of Death___________________________

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Veteran ________________ Branch of Service _________________________________

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Occupation of Deceased____________________________________________________

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Father's Full Name________________________________________________________

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Mother's Full Maiden Name_________________________________________________

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Religious Affiliation__________________________________________ ____________

Survivors________________________________________________________________

Education - Highest Grade Completed or Degree Earned__________________________

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Number of Certified Copies of the Death Certificate requested _____________________

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Accomplishments & Activities to be mentioned in the obituary:

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________________________________________________(survivors continued on back)

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