Obituaries

James Rich
B: 1941-02-16
D: 2018-11-11
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Rich, James
Ronald Mayes
D: 2018-11-07
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Mayes, Ronald
Anna Centers
B: 1945-08-10
D: 2018-11-06
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Centers, Anna
Kennedy Welch
D: 2018-10-18
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Welch, Kennedy
Beatrice Meador
B: 1930-11-24
D: 2018-10-06
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Meador, Beatrice
Louise Gardner
D: 2018-09-28
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Gardner, Louise
Francis Ward
D: 2018-09-20
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Ward, Francis
Thomas Branham
D: 2018-08-21
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Branham, Thomas
Patty Tabor
D: 2018-08-20
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Tabor, Patty
Wesley Hays
D: 2018-08-20
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Hays, Wesley
William Thompson
D: 2018-08-19
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Thompson, William
William Teague
D: 2018-08-02
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Teague, William
Russell Wheat
D: 2018-07-10
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Wheat, Russell
Junior Crone
B: 1950-01-03
D: 2018-06-30
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Crone, Junior
Donald Lyle
D: 2018-06-21
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Lyle, Donald
Carrel Willoughby
D: 2018-06-17
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Willoughby, Carrel
Barbara Mayes
D: 2018-05-30
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Mayes, Barbara
James Clayton III
D: 2018-05-29
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Clayton III, James
Ralph Meador
B: 1927-01-07
D: 2018-04-26
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Meador, Ralph
Joseph McReynolds
B: 1936-03-05
D: 2018-03-23
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McReynolds, Joseph
Georgiana Fisher
B: 1950-04-23
D: 2018-03-18
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Fisher, Georgiana

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Scottsville, KY 42164
Phone: (270) 622-2511
Fax: (270)-622-2612

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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:

Miscellaneous Notes and Instructions:

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