On-line Obituary Form

Please complete the form below and Major Family Funeral Home will write and submit an obituary to the Register-Guard.

NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

DECEDENT INFORMATION
Name of deceased, including nickname:
Sex:
Age:
Date of Death:	(e.g. MM/DD/YYYY)
City of residence:
Length of residence in Lane County area:
Date of Birth:	(e.g. MM/DD/YYYY)
Place of Birth:	City: State: Country:
Parents' names, mother's maiden name in parentheses: Example: John and Mary (Smith) Jones
Cause of death:
Career/work experience:
Military service:
Marital Status:	on (mm/dd/yyyy): in (city, state):
Life/domestic partner (synonymous with spouse):
Length of relationship:
Education
SURVIVORS
Spouse (life/domestic partner):
Date of Death of Spouse (if applicable):	(e.g. MM/DD/YYYY)
Parents(if living):
Grandparents(if living):
Children - Residence (indicate if son or daughter):
Siblings - Residence (indicate if brother or sister):
Number of grandchildren:
Number of great-grandchildren:
Number of great-great-grandchildren:
Preceded in death by (limited to spouses/children/grandchildren):
SERVICE INFORMATION
Type of service (funeral, memorial):
Check here if NO SERVICE IS PLANNED
	Time:
	Date: (e.g. MM/DD/YYYY)
	Location:
Visitation:
	Time:
	Date: (e.g. MM/DD/YYYY)
	Location:
Burial, entombment, inurnment (indicate which):
	Time:
	Date: (e.g. MM/DD/YYYY)
	Location:
Other Services:
	Time:
	Date: (e.g. MM/DD/YYYY)
	Location:
CONTACT INFORMATION
Memorial contributions to (organization, if applicable):
*Funeral home or cremation provider:
Telephone:
Family contact:
Telephone:
Please include a mailing address in the space below if you would like to receive up to 10 copies of this obituary.
No. of copies
* Name:
* Email Address:
Street Address:
City:
State:
IMPORTANT: Please check all facts, names, spellings and dates carefully on this entire form before signing below. We will not reprint obituaries to correct errors caused by incorrect or incomplete information on this form. I certify that I am a family member (or executor) and have proofread all the information as stated. I hereby authorize publication.
Signed:
Date:

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