Obituaries

JEFFREY DAVIS
B: 1954-12-17
D: 2017-09-11
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DAVIS, JEFFREY
WILLIAM DORSEY
B: 1928-08-19
D: 2017-09-09
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DORSEY, WILLIAM
Ruth Hutchinson
B: 1934-04-05
D: 2017-09-09
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Hutchinson, Ruth
SAMUEL LEVINE
B: 1932-03-11
D: 2017-09-07
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LEVINE, SAMUEL
FRANCIS FREEMAN
B: 1924-06-02
D: 2017-09-06
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FREEMAN, FRANCIS
Denise Nesbitt
B: 1965-12-11
D: 2017-08-29
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Nesbitt, Denise
Sylvia Crawford
B: 1942-11-08
D: 2017-08-28
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Crawford, Sylvia
GAVIN MINOR
B: 1981-12-06
D: 2017-08-21
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MINOR, GAVIN
DAVID THOMPSON
B: 1961-07-27
D: 2017-08-20
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THOMPSON, DAVID
ALLEN AVERY
B: 1956-12-30
D: 2017-08-14
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AVERY, ALLEN
Charlene Williams
B: 1966-11-04
D: 2017-08-14
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Williams, Charlene
TERRY JOHNSON
B: 1959-12-29
D: 2017-08-08
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JOHNSON, TERRY
Betty Pierce
D: 2017-08-05
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Pierce, Betty
Virgie Diggs
B: 1942-04-09
D: 2017-07-30
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Diggs, Virgie
STEPHEN BANKS
B: 1977-05-10
D: 2017-07-27
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BANKS, STEPHEN
Effie Brown
B: 1922-04-08
D: 2017-07-26
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Brown, Effie
DART BROWN
B: 1964-10-10
D: 2017-07-25
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BROWN, DART
Mary Day
B: 1947-06-30
D: 2017-07-23
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Day, Mary
KENTON McCREARY
B: 1954-12-03
D: 2017-07-23
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McCREARY, KENTON
CLIFFORD CALDWELL
B: 1938-03-11
D: 2017-07-21
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CALDWELL, CLIFFORD
Betty Allen
B: 1951-10-28
D: 2017-07-18
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Allen, Betty

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3700 Refugee Rd
COLUMBUS, OH 43232
Phone: 614-338-1965
Fax: 614-338-4287

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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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