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Obituary Form

Publish Notice In:

Deadline 5pm Friday for:

Amherst Bee

Clarence Bee

Ken-Ton Bee

Deadline Noon Monday for:

	Lancaster/Depew Bee		Cheektowaga Bee		West Seneca Bee		Orchard Park Bee
	East Aurora Bee

Funeral Director:		Daytime Phone Number:

Family Member to Contact:		Daytime Phone Number:

Personal Information

Full Name of Deceased:

Address:

Town:

State:

Zip:

How Long Resided at Address:

Date of Death:		Where:

Date of Birth:		Where:

Organizations, Clubs Belonged to:

If Employed, Where:		How Long:

Or Retired From:		When:

High School Attended:

College Attended:

Survivors

Spouse:

Children:

Sisters/Brothers:

Number of Grandchildren/Great Grandchildren:

Services

When:

Where:

Military Service

Rank, Honors, Where Stationed:

Other Information/Remarks About Deceased:

Donations Requested To:

Additional Comments

Additonal Comments:

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