On-line Obituary Form

The Obituary Form below allows you and your family to submit information to us about your loved one that you would like included in their obituary. Once we have received the obituary information from you we would be happy to write the obituary. You are also welcome to write your own. We will place an obituary for you in local and/or out-of-town papers of your choosing. Obituary charges vary greatly among papers and once the obituary is finalized we will be able to determine what each paper will charge you for running the obituary. A copy of the final obituary will also appear, at no charge, on our website, bohlenderfuneralchapel.com

If you have any questions, please contact Bohlender Funeral Chapel at (970)482-4244.
NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

 Personal Obituary

You are free to write an obituary in the box below exactly as you would like it to be worded and we will run the obituary as you have entered it. If you would like help writing an obituary, please skip this step and complete the information below.

 Deceased Information
* First Name:
* Last Name:
Middle Name:
Sex:
Age:
Date of Death: (e.g. MM/DD/YYYY)
Name of the Place of Death
(home / hospital name / other)
Address of the Place of Death
Long / short Term Illness(es):
Residence Area
(specific community / town / city):
Date of Birth: (e.g. MM/DD/YYYY)
Place of Birth: City:

State:

Country:
Marital Status:
Full Name of Surviving Spouse
(if applicable)
If Wife, Provide Maiden Name:
Date of Death of Spouse
(if applicable):		 (e.g. MM/DD/YYYY)
Usual Occupation (most of life):
Employer:
Job Title:
Dates of Employment:
Dates of Retirement:
Education
Religious Affiliations:
Clubs / Organizations / Memberships / Hobbies:
Honors/Awards:

 Veteran Information
Was Decendent Ever In the US Armed Forces?: Yes No (if no, continue to next section)
Branch of Service:
Date Enlisted: (e.g. MM/DD/YYYY)
Date Discharged: (e.g. MM/DD/YYYY)
Honorable Discharge: Yes No
Rank at Discharge:
Military Serial Number:
Is A Copy of Discharge Papers Available? Yes No (if no, please bring for us to copy):
Location where Discharge Papers are On File:

 Survivors

Newspapers will usually only use the names of immediate family members. If you would like, you may include the name(s) of the survivors' spouses. The city or town and state of the survivors and their spouses may be included as well. Separate each piece of the individual's information with a comma and a space. If there is more than one person or couple per text area, separate multiple individuals by hitting the "enter" key so that they each appear on a new line in the text area.
Daughters:
Sons:
Parents:
Sisters:
Brothers:
Grandparents:
Number of Grandchildren:
Names of Grandchildren:
Number of Great Grandchildren:
Names of Great
Grandchildren:
Name and Relationship of Those Preceding in Death:

 Service Date/Time/Place

Once you and/or your family have met with Bohlender Funeral Chapel to determine exact arrangements, any information regarding a service date, time and place will be added to the obituary for inclusion in the paper(s) of your choice.

 Newspaper Information

Please list the name and location (town and state) of the paper where you would like the obituary placed. It is fine to list more than one.

Newspaper Information:

 Information About Informant / Person In Charge Regarding this Obituary
* First Name:
* Last Name:
Relationship To Deceased:
* Email Address:
Telephone Number:

 Other Information & Instructions

Please list any other information you would like us to include. You may also use this box to advise us of any specific instructions regarding the obituary.


 

 

Bohlender Funeral Chapel | Fort Collins, Colorado 80524 | (970) 482-4244 |

© Copyright 2009 Bohlender Funeral Chapel and FuneralNet®
Home | Contact Us 

 

 
Infinite Menus, Copyright 2006, OpenCube Inc. All Rights Reserved.