This form is to be filled out by the funeral home handling the arrangements. It is provided online for easy access by funeral homes and to give families an outline of what information we are looking for, but please allow those handling the arrangements to submit this form.
Deadlines are 9 a.m. on the day of publication except for the Saturday edition which is 9:30 p.m. on Friday.
Contact Information
Funeral Home handling arrangements
Funeral Home phone number
Deceased's Information
Name
Age years
Residence (home, care facility)
Address
City
Time of Death AM   PM
Date of Death , 2009
Location of Death (Home, Care Facility)
City of Death
State of Death
Cause of Death (if under 65)
Date of Birth ,
Birth City
Birth State
Parents Information
Father's Name
Mother's Name
Mother's Maiden Name
Are Parents Living? Yes   No
If Living, where do parents reside?
Spouse Information
Was Deceased Married? Yes   No
Spouse's Name (including maiden name)
Date of Wedding ,
Is Spouse Living? Yes   No
Where does Spouse Reside?
Survivors' Information
Number of Surviving Sons
Surviving Sons' Names, Spouses' Names, towns and states
(also indicate degree of relation if not full. i.e: half, step)
Number of Surviving Daughters
Surviving Daughters' Names, Spouses' Names, towns and states
(also indicate degree of relation if not full. i.e: half, step)
Number of Surviving Brothers
Surviving Brothers' Names, Spouses' Names, towns and states
(also indicate degree of relation if not full. i.e: half, step)
Number of Surviving Sisters
Surviving Sisters' Names, Spouses' Names, towns and states
(also indicate degree of relation if not full. i.e: half, step)
Number of Surviving Grandchildren
Number of Surviving Great-Grandchildren
Deceased Relatives
Deceased Sons
(also indicate degree of relation if not full. i.e: half, step)
Deceased Daughters
(also indicate degree of relation if not full. i.e: half, step)
Deceased Brothers
(also indicate degree of relation if not full. i.e: half, step)
Deceased Sisters
(also indicate degree of relation if not full. i.e: half, step)
Number of Deceased Grandchildren
Number of Deceased Great-Grandchildren
Deceased's Activities
Occupation
Hold any public office? Yes   No
Office Held
Where was it held
When was it held
Veteran? Yes   No
Which Branch
Serve during war?
Memberships (church, societies, lodges)
with city and / or branch number for each
Funeral Information
Type Mass   Services
Funeral Date
Funeral Time
Funeral Location
Who will officiate?
Internment Yes   No
Internment Date
Internment Time
Will there be military services? Yes   No
Calling Date
Calling Time
Calling Location
Contributions to a charitable cause?
Other Information
Do you intend to submit a picture?
No
Yes, will email to The Daily Standard
Yes, will drop it off at The Daily Standard
Additional Pertinent Information
Weather forecast
for Saturday:
Partly cloudy
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