Online Obituary Request
Please read
guidelines
before filling out this form
1. Customer Information
Customer Name:
Customer Street Address/PO Box:
City:
State
Zip
Telephone:
Email:
(required)
2. Deceased's Information
First Name:
Middle Initial:
Last Name:
Date of Death:
(required)
Comments:
3. Handling Fees
Cost of Microfilm per Roll Searched:
$6.00
Shipping and Handling:
$2.00
Price per Page Copied:
$ .10
Will you accept fees?
yes
no
