109 East Oneida Preston, Idaho 83263 Phone:(208) 852-0533 Fax:(208) 852-1073
email:
webbmortuary@plmw.com
- Funeral Record -
(Information necessary for death certificate & obituary)
Deceased's Full Name
Age
Address
Birth Date
Birth Place
Doctor
Time Of Death
Father's Full Name
Birth Place
Mother's Full Name
Birth Place
Husband/Wife Of
Died
Date Of Marriage
Place
Husband/Wife Of
Died
Date Of Marriage
Place
Social Security #
Years of Education
Occupation
Informant (Names & Relations)
Address
Phone#
Place of Funeral
Date of Funeral
Time
Viewing
Officiant
Cemetery
Survivors
(Spouse, Children, Brothers, Sisters)
Name
Spouse
Relationship
Address (City & State)
Name
Spouse
Relationship
Address (City & State)
Name
Spouse
Relationship
Address (City & State)
Name
Spouse
Relationship
Address (City & State)
Name
Spouse
Relationship
Address (City & State)
Name
Spouse
Relationship
Address (City & State)
Name
Spouse
Relationship
Address (City & State)
Name
Spouse
Relationship
Address (City & State)
Name
Spouse
Relationship
Address (City & State)
Name
Spouse
Relationship
Address (City & State)
# Grandchildren
# Great Grandchildren
#Great-Great Grand Children
Preceded In Death By:
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
Items for Obituary
(Activities, Interests, Hobbies, Church Involvement, etc.)
Veteran: Branch of Service
Service#
VA File#
Date of Enlistment
Place
Date of Discharge
Place
Your Email
(required)
Additional Information:
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