Obituaries

Meredith Medley
B: 1977-10-21
D: 2017-02-20
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Medley, Meredith
Jeffrey Kemper
B: 1963-03-02
D: 2017-02-19
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Kemper, Jeffrey
Klinten Voss
B: 1969-06-21
D: 2017-02-19
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Voss, Klinten
Marie Sugranes
B: 1921-09-04
D: 2017-02-17
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Sugranes, Marie
Yvonne Norris
B: 1942-05-24
D: 2017-02-16
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Norris, Yvonne
Dorothy Agles
B: 1928-01-02
D: 2017-02-15
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Agles, Dorothy
Sharon Lewis
B: 1942-12-26
D: 2017-02-15
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Lewis, Sharon
Dorothy Agles
B: 1928-01-02
D: 2017-02-15
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Agles, Dorothy
Charles Chapman
B: 1932-06-06
D: 2017-02-15
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Chapman, Charles
Patricia Schultz
B: 1938-02-24
D: 2017-02-13
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Schultz, Patricia
Daniel Morgan
B: 1957-05-12
D: 2017-02-13
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Morgan, Daniel
Elizabeth Magnetti-Walls
B: 1953-07-11
D: 2017-02-11
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Magnetti-Walls, Elizabeth
Melvina DeSherlia
B: 1945-03-25
D: 2017-02-06
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DeSherlia, Melvina
Dale Langenwalter
B: 1933-11-16
D: 2017-01-29
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Langenwalter, Dale
Perry Radford
B: 1939-02-16
D: 2017-01-22
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Radford, Perry
Charles Romanik
B: 1947-03-25
D: 2017-01-22
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Romanik, Charles
Pamela Kloepping
B: 1952-01-20
D: 2017-01-19
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Kloepping, Pamela
John Power
B: 1947-08-20
D: 2017-01-19
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Power, John
Robert Kowalski
B: 1945-08-22
D: 2017-01-14
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Kowalski, Robert
Mark Berry
B: 1967-10-08
D: 2017-01-12
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Berry, Mark
Beverly Brown
B: 1947-03-13
D: 2017-01-11
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Brown, Beverly

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LEBANON, IL 62254
Phone: 618-622-4900
Fax: 618-622-4949

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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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