Obituary Form

This form may be filled out by the pastor, church secretary, church clerk, or communication leader. Please VERIFY spellings and dates.

Illinois Conference
Indiana Conference
Lake Region Conference
Michigan Conference
Wisconsin Conference

Please fill in blanks and VERIFY all information.


Never married
Married, divorced or widowed

Surviving Family Members: Give each man's given name, initial, and family name as he is known, and give each woman's given name and initial, (maiden name), and married name. Separate the family members' names with commas. Do not list deceased family members.

These are the only family members we list. Aunts and uncles, nieces and nephews, and cousins are not listed. Space does not permit listing the city where each surviving family member lives.

Survivors Include:

His Wife
Her Husband


Funeral services were conducted by
Graveside services were conducted by
Memorial services were conducted by
Interment (if buried) was in
Inurnment (if cremated) was in
Private inurnment (if deceased's ashes were given to the family)

NOTE: These records may be used by people who are doing genealogy research, so the information must be as complete and accurate as possible. Be particularly careful to include the women's full names, including the maiden name (if possible), so people can trace both sides of their family tree.

Incomplete obituaries may not be published. If you intend to leave a blank unfilled, write N/A (not applicable) in the space, so the editors will know you didn't just miss filling it in.

Please click the Submit button when the form is completely filled in.