Obituaries

Tamara Miller-Fuller
B: 1970-01-08
D: 2017-10-11
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Miller-Fuller, Tamara
Charles Rouse
B: 1935-12-19
D: 2017-09-16
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Rouse, Charles
Gordon Main
B: 1953-04-22
D: 2017-09-12
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Main, Gordon
Cato Allsup
B: 1949-12-27
D: 2017-09-10
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Allsup, Cato
Charles Hansen
B: 1946-12-19
D: 2017-09-07
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Hansen, Charles
Donald Bearbower
B: 1958-03-16
D: 2017-08-30
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Bearbower, Donald
Donald Becker
B: 1956-06-01
D: 2017-08-28
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Becker, Donald
Thadius Warnke
B: 1997-01-30
D: 2017-08-19
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Warnke, Thadius
Donald Greenley
B: 1947-05-11
D: 2017-08-16
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Greenley, Donald
Dolores Shannon
B: 1943-05-06
D: 2017-08-14
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Shannon, Dolores
Stephen Kalkbrenner
B: 1948-09-03
D: 2017-08-12
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Kalkbrenner, Stephen
Barbara Kirkpatrick
B: 1954-02-17
D: 2017-08-09
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Kirkpatrick, Barbara
Janis Corkery
B: 1937-04-24
D: 2017-08-05
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Corkery, Janis
Jerry Boubin
B: 1961-04-22
D: 2017-08-04
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Boubin, Jerry
Doris Butters
B: 1929-04-01
D: 2017-07-25
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Butters, Doris
George Darland
B: 1960-08-30
D: 2017-07-18
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Darland, George
Dawn Rouse
B: 1967-03-03
D: 2017-07-17
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Rouse, Dawn
Harry Backer
B: 1961-08-21
D: 2017-07-17
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Backer, Harry
Kenneth Lynch
B: 1951-12-11
D: 2017-07-05
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Lynch, Kenneth
William Zimpher
B: 1942-03-24
D: 2017-06-27
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Zimpher, William
Lester McGlaughlin
B: 1943-12-14
D: 2017-06-27
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McGlaughlin, Lester

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216 3rd Ave. SE.
Independence, IA 50644
Phone: (319) 334-2501
Fax: (319) 334-2502

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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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