For the record: Deaths

First name:

Middle name:

Last name:

Maiden name:

Age at death:

Home city:

Date of birth (MM-DD-YYYY): - -

Born at (City/County/State):

Date of death (MM-DD-YYYY): - -

Died at (City/County/State):

Cause of death:

Is a member of Mennonite Church USA: No Yes

Spouse: Living Deceased None

Spouse's first name:

Spouse's middle name:

Spouse's last name:

Spouse's maiden name:

Spouse's date of birth (MM-DD-YYYY): - -

Spouse's date of death (MM-DD-YYYY): - -

Date of marriage (MM-DD-YYYY): - -

Married at (City/County/State):

Mother: Living Deceased

Mother's first name:

Mother's middle name:

Mother's last name:

Mother's maiden name:

Mother's date of birth (MM-DD-YYYY): - -

Mother's date of death (MM-DD-YYYY): - -

Father: Living Deceased

Father's first name:

Father's middle name:

Father's last name:

Father's date of birth (MM-DD-YYYY): - -

Father's date of death (MM-DD-YYYY): - -

Surviving children (including spouses):

Number of grandchildren:

Number of great-grandchildren:

Number of great-great-grandchildren:

Additional marriage information:

Deceased children:

Deceased grandchildren:

Surviving siblings (include spouses):

Deceased siblings:

Date of funeral (MM-DD-YYYY): - -

Funeral/Memorial Service location (name of church or funeral home):

Funeral City/County:

Funeral state:

Burial cemetery:

Burial location (city/county, state):

Significant events or activities:

*Items in italics will be listed in MennObits, your space for memorial and historical records.

Contact name:

Contact email:

Contact phone:

Contact mailing address (please include city, state, and zip):

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