Obituary Information Fact Sheet
Name of deceased: 	
Date of death: 	
Age at death: 	
Location of death: 	
Cause of death: 	
Birthplace: 	
Address: 		
Length of time in community: 	
Religious affiliation or membership: 	
High school, college, or graduate degrees: 		
Professional degrees or affiliations: 		
Military service: 	
Profession: 	
Interesting personal facts: 			
Survived by: [Names of survivors—spouses, siblings, in-laws, children, grandchildren, etc.—and their relationship to deceased] 		
Predeceased by: [Names of spouses, siblings, and children who predeceased and when deaths occurred]
			 
Time and location of funeral arrangements and services: [often supplied by the funeral home] 			
For further information, contact: