Obituaries

David Hull
B: 1932-05-30
D: 2017-02-21
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Hull, David
Ramon Rodriguez
B: 1931-03-11
D: 2017-02-18
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Rodriguez, Ramon
Clyde Johnston
B: 1921-10-26
D: 2017-02-15
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Johnston, Clyde
John Lecours
B: 1939-03-27
D: 2017-02-06
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Lecours, John
Joanna Bass
B: 1940-10-23
D: 2017-02-06
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Bass, Joanna
Richard McCormick
B: 1936-09-27
D: 2017-02-05
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McCormick, Richard
Paul St. Amant
B: 1960-10-16
D: 2017-01-31
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St. Amant, Paul
David "Sonny" Rogers
B: 1930-06-15
D: 2017-01-27
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Rogers, David "Sonny"
David Rogers
B: 1930-06-15
D: 2017-01-27
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Rogers, David
Peggy Nicholson
B: 1953-10-25
D: 2017-01-24
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Nicholson, Peggy
Robert Deline
B: 1925-12-04
D: 2017-01-22
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Deline, Robert
Ralph Flemming
B: 1938-03-02
D: 2017-01-14
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Flemming, Ralph
Barry Gaffney
B: 1954-12-20
D: 2017-01-14
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Gaffney, Barry
Jean McCloskey
B: 1950-12-11
D: 2017-01-10
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McCloskey, Jean
Thomas Truhlar
B: 1949-03-21
D: 2017-01-08
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Truhlar, Thomas
Elinor Cone
B: 1938-08-04
D: 2017-01-01
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Cone, Elinor
Martha Rosenbaum
B: 1920-10-14
D: 2016-12-31
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Rosenbaum, Martha
Norma Cole
B: 1936-06-18
D: 2016-12-29
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Cole, Norma
David Nalley
B: 1955-07-02
D: 2016-12-19
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Nalley, David
Mary Melvin
B: 1928-12-20
D: 2016-12-18
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Melvin, Mary
Linda Najduch
B: 1953-05-01
D: 2016-12-14
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Najduch, Linda

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Holly Hill, FL 32117
Phone: (386) 253-7601
Fax: (386) 253-7647

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I. Biographical Information
 
Full Name:
Date of Death:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded In Death
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

II. Military Record

Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences

Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

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