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

Obituaries

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 "Irene" May
B: 1935-05-28
D: 2017-07-28
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May, Norma "Irene"
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
Deloris "Dee' Stamm
B: 1940-11-16
D: 2017-06-24
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Stamm, Deloris "Dee'
D'James "DJ" Moore
B: 2000-04-19
D: 2017-06-22
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Moore, D'James "DJ"
Mary Skulsky
B: 1923-03-09
D: 2017-06-14
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Skulsky, Mary
Susan Jolly
B: 1952-05-05
D: 2017-06-08
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Jolly, Susan
Barbara Raetz VanEgeren
B: 1957-10-15
D: 2017-06-08
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VanEgeren, Barbara Raetz
Leona M. "Lee" Hull
B: 1932-02-13
D: 2017-06-07
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Hull, Leona M. "Lee"
Carolyn Cunningham
B: 1943-11-16
D: 2017-06-06
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Cunningham, Carolyn
Marilyn Roth
B: 1931-06-18
D: 2017-05-29
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Roth, Marilyn
Benjamin "Benny" Ulmer
B: 1947-02-13
D: 2017-05-27
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Ulmer, Benjamin "Benny"
James Harry "Jim" Von Handorf
B: 1947-03-06
D: 2017-05-22
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Von Handorf, James Harry "Jim"
Norman Howard "Howie" Micklem
B: 1963-06-26
D: 2017-05-22
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Micklem, Norman Howard "Howie"

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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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