Obituary Information Form

Instructions: Please fill out this form and click the SUBMIT button to send your information electronically.

Obituaries are printed on a space-available basis and will be edited to match our style.

You may also print this form and mail or deliver in person to Community News, Maryland Gazette, 306 Crain Highway S.W., Glen Burnie, MD 21061. You may also fax it to: 410-766-7031, attention: Community News.

Family contact information

Family contact name
Phone number (daytime)
Email address
Address
City
State
Zip code

Name of deceased in full (no initials)
Nickname (if any)
Sex of deceased
Age
Home Area
Length of residence
Previous residence
Date of death
Place of death
Cause of death
Length of illness

Life history

Date of birth
Birthplace

Education (where and when, degrees)	Employment (positions, where and when)

Military (rank, service assignments, medals)	Unusual or interesting achievements

Memberships in churches/organizations, offices held	Hobbies and interests

Survivors

Name of Spouse
Status	If deceased, when?
When Married
Name of former spouse
When Divorced

Sons	Residence (city/state)






Daughters	Residence (city/state)






Brothers	Residence (city/state)






Sisters	Residence (city/state)

Grandchildren
Number of grandchildren
Number of great-grandchildren
Number of great-great-grandchildren

Parents (if living)	Residence (city/state)



Grandparents (if living)	Residence (city/state)





Others (such as guardians)	Residence (city/state)

Arrangements

Visitation

Time	Date	Place

Christian Wake

Time	Date	Place

Services

Private
Public

Type:

Details:

	Funeral
	Funeral Mass
	Graveside
	Mass of Christian Burial
	Memorial
	Memorial Mass
	Other:

Time:	Date:

Place/Address:

Disposition

Private
Public

Type:

Details:

	Burial
	Inurnment
	Other:

Time:	Date:

Place/Address:

Arrangements
made through...

Anatomy Board
Crematory
Funeral Home

Funeral home information:

Donations:

Name:
Address:
City:
State:
Zip code:
Contact name & phone no.:

No
Yes
In lieu of flowers

Send to:

	Name/Attn.:
	Address:

Comments

Include a photo:
Your vertical photo must be clear and close-up. When mailing or delivering personally, enclose a self-addressed, stamped envelope if you want the photo returned. A black and white photo is preferable.

Include a photo now (.gif/.jpg)

-or-

I will email my digital photo to gazstaff@mdgazette.com
I will enclose a photo with my printed form
Please print my obituary without a photo

Please double-check the information you've entered before submitting this form.