Obituaries

Donald Boies
B: 1926-09-11
D: 2018-01-03
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Boies, Donald
Lori Williams
B: 1964-05-09
D: 2017-12-30
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Williams, Lori
Larry Regenold
B: 1944-12-19
D: 2017-12-18
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Regenold, Larry
Roxann Funk
B: 1961-09-14
D: 2017-12-17
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Funk, Roxann
Scott Gordon
B: 1963-01-14
D: 2017-12-17
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Gordon, Scott
Robert Hills
B: 1963-04-16
D: 2017-12-14
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Hills, Robert
Lois Huber
B: 1925-09-11
D: 2017-12-13
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Huber, Lois
Dwayne Weber
B: 1962-05-19
D: 2017-12-03
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Weber, Dwayne
Randy Kaufman
B: 1957-04-06
D: 2017-12-02
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Kaufman, Randy
John Baker
B: 1926-04-12
D: 2017-11-21
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Baker, John
Sondra Peck
B: 1949-01-09
D: 2017-11-12
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Peck, Sondra
James Kelley
B: 1922-07-25
D: 2017-11-08
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Kelley, James
Jason Hunziker
B: 1978-01-23
D: 2017-11-06
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Hunziker, Jason
Joyce Cornwell
B: 1936-05-29
D: 2017-10-13
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Cornwell, Joyce
Justin Junk
B: 1982-12-10
D: 2017-10-10
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Junk, Justin
Dennis McLane
B: 1952-03-03
D: 2017-10-08
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McLane, Dennis
Marjorie Seufferlein
B: 1928-01-30
D: 2017-09-29
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Seufferlein, Marjorie
Charles Rouse
B: 1935-12-19
D: 2017-09-16
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Rouse, Charles
Gordon Main
B: 1953-04-22
D: 2017-09-12
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Main, Gordon
Tamara Miller-Fuller
B: 1970-01-08
D: 2017-09-11
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Miller-Fuller, Tamara
Cato Allsup
B: 1949-12-27
D: 2017-09-10
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Allsup, Cato

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Independence, IA 50644
Phone: (319) 334-2501
Fax: (319) 334-2502

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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:
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Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

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