92 W. Franklin St.
Bellbrook, OH 45305
Phone: 937-848-6651
Fax: 1-800-786-3304

Obituaries

George Simmons
B: 1932-03-27
D: 2017-04-27
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Simmons, George
Constance "Connie" Ross
B: 1937-12-18
D: 2017-04-13
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Ross, Constance "Connie"
Kay Teeters
B: 1944-05-22
D: 2017-04-11
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Teeters, Kay
Robert Thompson
B: 1924-11-06
D: 2017-04-08
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Thompson, Robert
George Janicki
B: 1928-09-11
D: 2017-04-07
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Janicki, George
James "Jim" Angel
B: 1935-05-12
D: 2017-04-01
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Angel, James "Jim"
Gregory Maynard
B: 1956-02-18
D: 2017-03-26
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Maynard, Gregory
Sandra Haman
B: 1935-02-18
D: 2017-03-24
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Haman, Sandra
William Taylor
B: 1928-04-26
D: 2017-03-22
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Taylor, William
Sherri Wojick
B: 1959-05-07
D: 2017-03-20
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Wojick, Sherri
Teresa Phillips
B: 1950-10-11
D: 2017-03-18
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Phillips, Teresa
Charles Lucas
B: 1925-05-01
D: 2017-03-14
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Lucas, Charles
Carley Ingram
B: 1954-01-22
D: 2017-03-11
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Ingram, Carley
Ralph Owens
B: 1937-08-23
D: 2017-03-01
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Owens, Ralph
Mildred Hamilton
B: 1926-06-27
D: 2017-02-23
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Hamilton, Mildred
Philidina Keating
B: 1931-10-19
D: 2017-02-22
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Keating, Philidina
Robert Fortune
B: 1957-09-07
D: 2017-02-21
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Fortune, Robert
Joanne Rymoff
B: 1940-01-04
D: 2017-02-19
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Rymoff, Joanne
Betty Goldey
B: 1931-10-07
D: 2017-02-15
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Goldey, Betty
Earl Teague
B: 1929-04-07
D: 2017-02-11
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Teague, Earl
Marilyn Lamb
B: 1937-04-10
D: 2017-02-06
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Lamb, Marilyn

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I. Biographical Information
 
Full Name:
Date of Death:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded In Death
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

II. Military Record

Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences

Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

Miscellaneous Notes and Instructions:

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