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Obituaries

Michael Gross
B: 1961-03-23
D: 2018-01-13
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Gross, Michael
Mary Ganser
B: 1926-08-02
D: 2018-01-10
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Ganser, Mary
Stanley Lukaszewski
B: 1925-01-22
D: 2018-01-08
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Lukaszewski, Stanley
Janet Palmer
B: 1946-10-20
D: 2018-01-03
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Palmer, Janet
Helen Stowe
B: 1927-08-01
D: 2018-01-02
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Stowe, Helen
Channing Michalski
B: 1971-04-09
D: 2018-01-02
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Michalski, Channing
Dale Russell
B: 1941-12-26
D: 2017-12-28
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Russell, Dale
Barbara Whiting
B: 1950-03-16
D: 2017-12-27
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Whiting, Barbara
Eleanore Szpera
B: 1913-10-20
D: 2017-12-25
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Szpera, Eleanore
Vincent Lippert
B: 1942-03-28
D: 2017-12-25
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Lippert, Vincent
Joseph Burnett
B: 1923-01-24
D: 2017-12-24
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Burnett, Joseph
John Urban
B: 1933-07-17
D: 2017-12-20
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Urban, John
Frieda Langholff
B: 1924-01-02
D: 2017-12-10
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Langholff, Frieda
Robin Newton
B: 1960-11-09
D: 2017-12-09
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Newton, Robin
Marcella Michaelis
B: 1924-07-25
D: 2017-11-30
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Michaelis, Marcella
Ione Schopen
B: 1940-08-02
D: 2017-11-18
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Schopen, Ione
Robert Mattke
B: 1955-06-26
D: 2017-11-15
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Mattke, Robert
Norma Elgas
B: 1928-08-03
D: 2017-11-12
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Elgas, Norma
Forrest Haggerty
B: 1932-04-13
D: 2017-11-07
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Haggerty, Forrest
Judy Richards
B: 1943-05-08
D: 2017-11-03
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Richards, Judy
Dean Stephan
B: 1937-01-22
D: 2017-10-29
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Stephan, Dean

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Jefferson, WI 53549
Phone: 920-674-3960
Fax: 920-674-6446

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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
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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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