Name and Date of Death
Password This is CASE Sensitive. Please choose a password that you will remember. You must select a password to later return to edit the death notice.
First Name
Middle Name(s) or Initial(s)
Last Name
Suffix (Sr., Jr., III, etc.)
Distinctions
Did the person have a distinction, rank or title that you would like to recognize? Examples of distinctions or titles are U.S. Army, Ret. or Lt. Col. USAF (Ret.)
Date of Death
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Yes
No
Do you want to list the age at the time of death?
If yes, enter the age here:
Yes
No
If you are preparing a Death Notice for a woman, do you want to list the maiden name?
If yes, enter the maiden surname here:
Yes 
No 
Would you like the Death Notice to state that the person died suddenly?
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Residence
City
State:
Please Choose State/Province...
None Specified
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I do not live in Canada/USA
Other State:
Country:
Please Choose a Country...
---------------------------
None Specified
U.S.A.
Canada
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Albania
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Aruba
Ascension
Australia
Austria
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Azores
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Benin
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Bhutan
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Botswana
Brazil
British Virgin Islands
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Bulgaria
Burkina Faso
Burma
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo
Corsica
Costa Rica
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
England
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guatemala
Guinea
Guinea Bissau
Guyana
Haiti
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Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Republic of Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
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Lesotho
Libya
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Lithuania
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Nigeria
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Pitcairn Island
Poland
Portugal
Qatar
Reunion
Romania
Russia
Rwanda
San Marino
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Saudi Arabia
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Senegal
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Seychelles
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Spain
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Wales
Wallis and Futuna Islands
Western Samoa
Yemen
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Current
Former
Was this the current residence or a former residence?
Surviving Relations
You may enter as may different names of relations as you like.
Choose as many of the following phrases that apply and fill in the full names in the boxes. If you want to list a name of someone who is not living, type in the phrase "the late" before the person's name. For example, you might fill in the names of the children as: Jane A. Doe, Robert B. Roe and the late Betty Roe Smith.
Include
Choose Modifier...
beloved
(Other)
(No modifier)
Other:
wife
husband
former wife
former husband
of
Include
Choose Modifier...
beloved
devoted
loving
dear
cherished
(Other)
(no modifier)
Other:
mother
father
of
Include
Choose Modifier...
beloved
devoted
loving
dear
cherished
(Other)
(no modifier)
Other:
grandmother
grandfather
of
Include
Choose Modifier...
beloved
devoted
loving
dear
cherished
(Other)
(no modifier)
Other:
daughter
son
of
Include
Choose Modifier...
beloved
devoted
loving
dear
cherished
(Other)
(no modifier)
Other:
granddaughter
grandson
of
Other Surviving Relations
Include Skip this section
If there are other surviving relations besides those listed immediately above, click the checkbox to the left and complete the following information. You may enter up to ten different relations additional to those above. If you do not wish to add any surviving relations other than those you listed immediately above, then leave the rest of the information blank.
Choose one:
He is also survived by
She is also survived by
Other survivors include
Additional Relations #1
Include
Choose Modifier...
many
numerous
several
a host of
a
one
two
three
four
five
six
seven
eight
nine
ten
his
her
(no modifier)
(Other)
Other:
Additional Relation #1
sister
sisters
brother
brothers
siblings
granddaughter
granddaughters
grandson
grandsons
grandchild
grandchildren
great granddaughter
great granddaughters
great grandson
great grandsons
great grandchild
great grandchildren
god daughter
god daughters
god son
god child
god children
aunt
aunts
uncle
uncles
niece
nieces
nephew
nephews
nieces and nephews
cousin
cousins
mother-in-law
father-in-law
sister-in-law
sisters-in-law
brother-in-law
brothers-in-law
relatives and friends
(Other)
Other:
If you want their names to appear in the Death Notice, specify the name or names of the relatives referred to above:
Additional Relations #2
Include
Choose Modifier...
many
numerous
several
a host of
a
one
two
three
four
five
six
seven
eight
nine
ten
his
her
(no modifier)
(Other)
Other:
Additional Relation #2
sister
sisters
brother
brothers
siblings
granddaughter
granddaughters
grandson
grandsons
grandchild
grandchildren
great granddaughter
great granddaughters
great grandson
great grandsons
great grandchild
great grandchildren
god daughter
god daughters
god son
god child
god children
aunt
aunts
uncle
uncles
niece
nieces
nephew
nephews
nieces and nephews
cousin
cousins
mother-in-law
father-in-law
sister-in-law
sisters-in-law
brother-in-law
brothers-in-law
relatives and friends
(Other)
Other:
If you want their names to appear in the Death Notice, specify the name or names of the relatives referred to above:
Additional Relations #3
Include
Choose Modifier...
many
numerous
several
a host of
a
one
two
three
four
five
six
seven
eight
nine
ten
his
her
(no modifier)
(Other)
Other:
Additional Relation #3
sister
sisters
brother
brothers
siblings
granddaughter
granddaughters
grandson
grandsons
grandchild
grandchildren
great granddaughter
great granddaughters
great grandson
great grandsons
great grandchild
great grandchildren
god daughter
god daughters
god son
god child
god children
aunt
aunts
uncle
uncles
niece
nieces
nephew
nephews
nieces and nephews
cousin
cousins
mother-in-law
father-in-law
sister-in-law
sisters-in-law
brother-in-law
brothers-in-law
relatives and friends
(Other)
Other:
If you want their names to appear in the Death Notice, specify the name or names of the relatives referred to above:
Additional Relations #4
Include
Choose Modifier...
many
numerous
several
a host of
a
one
two
three
four
five
six
seven
eight
nine
ten
his
her
(no modifier)
(Other)
Other:
Additional Relation #4
sister
sisters
brother
brothers
siblings
granddaughter
granddaughters
grandson
grandsons
grandchild
grandchildren
great granddaughter
great granddaughters
great grandson
great grandsons
great grandchild
great grandchildren
god daughter
god daughters
god son
god child
god children
aunt
aunts
uncle
uncles
niece
nieces
nephew
nephews
nieces and nephews
cousin
cousins
mother-in-law
father-in-law
sister-in-law
sisters-in-law
brother-in-law
brothers-in-law
relatives and friends
(Other)
Other:
If you want their names to appear in the Death Notice, specify the name or names of the relatives referred to above:
Additional Relations #5
Include
Choose Modifier...
many
numerous
several
a host of
a
one
two
three
four
five
six
seven
eight
nine
ten
his
her
(no modifier)
(Other)
Other:
Additional Relation #5
sister
sisters
brother
brothers
siblings
granddaughter
granddaughters
grandson
grandsons
grandchild
grandchildren
great granddaughter
great granddaughters
great grandson
great grandsons
great grandchild
great grandchildren
god daughter
god daughters
god son
god child
god children
aunt
aunts
uncle
uncles
niece
nieces
nephew
nephews
nieces and nephews
cousin
cousins
mother-in-law
father-in-law
sister-in-law
sisters-in-law
brother-in-law
brothers-in-law
relatives and friends
(Other)
Other:
If you want their names to appear in the Death Notice, specify the name or names of the relatives referred to above:
Additional Relations #6
Include
Choose Modifier...
many
numerous
several
a host of
a
one
two
three
four
five
six
seven
eight
nine
ten
his
her
(no modifier)
(Other)
Other:
Additional Relation #6
sister
sisters
brother
brothers
siblings
granddaughter
granddaughters
grandson
grandsons
grandchild
grandchildren
great granddaughter
great granddaughters
great grandson
great grandsons
great grandchild
great grandchildren
god daughter
god daughters
god son
god child
god children
aunt
aunts
uncle
uncles
niece
nieces
nephew
nephews
nieces and nephews
cousin
cousins
mother-in-law
father-in-law
sister-in-law
sisters-in-law
brother-in-law
brothers-in-law
relatives and friends
(Other)
Other:
If you want their names to appear in the Death Notice, specify the name or names of the relatives referred to above:
Additional Relations #7
Include
Choose Modifier...
many
numerous
several
a host of
a
one
two
three
four
five
six
seven
eight
nine
ten
his
her
(no modifier)
(Other)
Other:
Additional Relation #7
sister
sisters
brother
brothers
siblings
granddaughter
granddaughters
grandson
grandsons
grandchild
grandchildren
great granddaughter
great granddaughters
great grandson
great grandsons
great grandchild
great grandchildren
god daughter
god daughters
god son
god child
god children
aunt
aunts
uncle
uncles
niece
nieces
nephew
nephews
nieces and nephews
cousin
cousins
mother-in-law
father-in-law
sister-in-law
sisters-in-law
brother-in-law
brothers-in-law
relatives and friends
(Other)
Other:
If you want their names to appear in the Death Notice, specify the name or names of the relatives referred to above:
Additional Relations #8
Include
Choose Modifier...
many
numerous
several
a host of
a
one
two
three
four
five
six
seven
eight
nine
ten
his
her
(no modifier)
(Other)
Other:
Additional Relation #8
sister
sisters
brother
brothers
siblings
granddaughter
granddaughters
grandson
grandsons
grandchild
grandchildren
great granddaughter
great granddaughters
great grandson
great grandsons
great grandchild
great grandchildren
god daughter
god daughters
god son
god child
god children
aunt
aunts
uncle
uncles
niece
nieces
nephew
nephews
nieces and nephews
cousin
cousins
mother-in-law
father-in-law
sister-in-law
sisters-in-law
brother-in-law
brothers-in-law
relatives and friends
(Other)
Other:
If you want their names to appear in the Death Notice, specify the name or names of the relatives referred to above:
Additional Relations #9
Include
Choose Modifier...
many
numerous
several
a host of
a
one
two
three
four
five
six
seven
eight
nine
ten
his
her
(no modifier)
(Other)
Other:
Additional Relation #9
sister
sisters
brother
brothers
siblings
granddaughter
granddaughters
grandson
grandsons
grandchild
grandchildren
great granddaughter
great granddaughters
great grandson
great grandsons
great grandchild
great grandchildren
god daughter
god daughters
god son
god child
god children
aunt
aunts
uncle
uncles
niece
nieces
nephew
nephews
nieces and nephews
cousin
cousins
mother-in-law
father-in-law
sister-in-law
sisters-in-law
brother-in-law
brothers-in-law
relatives and friends
(Other)
Other:
If you want their names to appear in the Death Notice, specify the name or names of the relatives referred to above:
Additional Relations #10
Include
Choose Modifier...
many
numerous
several
a host of
a
one
two
three
four
five
six
seven
eight
nine
ten
his
her
(no modifier)
(Other)
Other:
Additional Relation #10
sister
sisters
brother
brothers
siblings
granddaughter
granddaughters
grandson
grandsons
grandchild
grandchildren
great granddaughter
great granddaughters
great grandson
great grandsons
great grandchild
great grandchildren
god daughter
god daughters
god son
god child
god children
aunt
aunts
uncle
uncles
niece
nieces
nephew
nephews
nieces and nephews
cousin
cousins
mother-in-law
father-in-law
sister-in-law
sisters-in-law
brother-in-law
brothers-in-law
relatives and friends
(Other)
Other:
If you want their names to appear in the Death Notice, specify the name or names of the relatives referred to above:
Information About the Funeral Arrangements
Visitation Visitation
No Visitation
If there will be a visitation, please specify the following:
Choose one of the following phrases:
Friends may call at
The family will receive friends at
Viewing at
What is the name of the funeral home?
Address of the funeral home
When is the visitation?
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
To include the year with the date on the death notice, type it in above.
Is there a second visitation on the same day?
No Yes
...If yes,
Will there be a second day of visitation?
No
Yes
...If yes, enter the following information about the second visitation:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Is there a second visitation on the same day?
No Yes
...If yes,
When is the Funeral?
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Time of Funeral: a.m. p.m. noon
Location of Funeral
Funeral service at the funeral home
Funeral service at a church or other location
Graveside service
Private service
If the funeral service will be held at a church or other location, please provide the following information.
Choose one:
A funeral service will be held
Services will be held
A memorial service will be held
A mass of Christian burial will be celebrated
Funeral mass
If you selected "funeral service at a church or other location" above, please specified the name and address of the church or other location:
Burial or Cremation
Burial Cremation
If you chose burial, provide the following information:
Name of the cemetary
Address of the cemetary
Will burial be with full military honors?
Yes
Not Relevant
Memorial Contributions
Specify a charity
If you specified immediately above that memorial contributions are to be made in lieu of flowers, please specify a charity.
Choose from this list or specify in the space below...
charity one
A Charity of One's Choice
Other, specify...
If you do not see the charity you want to name on the list, choose the last item (Other) and enter the name of your charity.
If you choose a charity from our list -- we will include a link from the Death Notice directly to that charity's web site. If you would like to supply a web address for an online donation with your charity, put this Web address in parenthesis, such as (http://www.cancersociety.org).
Contact Information
Name (required)Fill in the information below if you would like to be contacted with questions about this death notice or the funeral arrangements.
(Provide your name, or the name of your funeral home.)
Email Address
Yes
No Would you like to be contacted with questions about the death notice or the funeral arrangements?
Phone If yes, provide your telephone number in the space below: If no phone number is specified, your email address will be the only contact information provided.