Digital Background & Obituary Form

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Digital Background& Obituary Form

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Primary Contact

Relationship to Decedent

Background & Information

All information requested below is required by the State of Ohio.

Decedents Sex*

Female

Male

Decedent ever in Armed Forces?*

Yes

No

Decedents Marital Status

*(If Wife, give name prior to First Marriage)

Decedents Race*

White

Black or African American

American Indian or Alaskan Native

Korean

Vietnamese

Other Asian

Other Pacific Islander

Decedent of Hispanic Origin?*

No

Mexican, Mexican American or Chicano

Puerto Rican

Cuban

Decedents Level of Education

* (do not use retired)

Decedent Location of Death

Please fill out the following to the best of your ability.

Obituary Photo can be an image type of JPG or PNG

Choose File

Allowed files: .jpg, .jpeg, .png

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