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

Obituaries

Beverly Peckolt
B: 1938-04-16
D: 2017-10-10
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Peckolt, Beverly
Caleigh Faith Hildebrandt
B: 1993-07-27
D: 2017-10-05
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Hildebrandt, Caleigh Faith
Dottie Hubbell
B: 1946-09-23
D: 2017-10-02
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Hubbell, Dottie
Hughie Russell
B: 1938-01-10
D: 2017-10-01
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Russell, Hughie
Robert Barnes
B: 1937-10-28
D: 2017-09-26
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Barnes, Robert
Donald Moore
B: 1919-08-11
D: 2017-09-25
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Moore, Donald
Eric Wright
B: 1969-01-01
D: 2017-09-25
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Wright, Eric
James White
B: 1934-02-01
D: 2017-09-21
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White, James
Regina Pittman
B: 1955-01-06
D: 2017-09-16
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Pittman, Regina
Cynthia Klingle
B: 1967-07-13
D: 2017-09-10
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Klingle, Cynthia
Vaughn Lewis
B: 1927-06-20
D: 2017-08-27
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Lewis, Vaughn
Sally Rogers
B: 1929-01-09
D: 2017-08-18
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Rogers, Sally
Linda Fisher
B: 1947-10-08
D: 2017-08-07
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Fisher, Linda
Jack Beckett
B: 1940-02-01
D: 2017-08-05
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Beckett, Jack
Norma May
B: 1935-05-28
D: 2017-07-28
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May, Norma
Bessie Diamond
B: 1933-04-08
D: 2017-07-24
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Diamond, Bessie
Wilmer Nussbaum
B: 1920-10-24
D: 2017-07-20
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Nussbaum, Wilmer
Ella Peck
B: 1929-02-27
D: 2017-07-08
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Peck, Ella
Darrell Hutchinson
B: 1939-02-20
D: 2017-07-08
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Hutchinson, Darrell
Lillabelle "Jonnie" Burge
B: 1920-07-04
D: 2017-07-03
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Burge, Lillabelle "Jonnie"
Francis Boyer
B: 1957-05-22
D: 2017-06-27
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Boyer, Francis

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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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Please place my information on file


 

 

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