For the Central California Conference

In order for the obituary to appear in the Recorder, ALL items (including city and state of birth/death MUST be filled out completely.

Name of Deceased*

First

Last

Deceased Church Membership:*

Date of Birth:*

mm/dd/yyyy

Place of Birth (City & State):*

Date of Death:*

mm/dd/yyyy

Place of Death (City & State):*

Date of Funeral:

Survivors:*List in order of closest relationship: 1. spouse, sons, and daughters, etc; 2. a child or young unmarried person; parents, brothers, sisters, grandparents, etc.3. If no living survivors please state "None"

Address of Deceased:*

Address 1

Address 2

City

State

Postal Code

Country

Optional Information:If deceased was a pastor, missionary or other denominational worker please summarize infomation (limit to 25 or fewer words). If the obit is special (young person, unusual circumstances or too many survivors to fit the included blanks, etc.) please explain/list here:

Obit submitted by:*

First

Last

Phone Number for Obit Submitter:*

Departments

Ministries

Notice of Death