The Clackamas Review
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(• denotes required fields.)
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General information
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• Funeral home:
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• Name of deceased:
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• Maiden name if female:
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• City of residence:
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Service
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• Type of service:
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Funeral
Mass
Memorial
Graveside
Other
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If other:
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• Access:
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Private
Public
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• Location of service: (name of site, street address):
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• Time of service:
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• Date of service:
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Visitation
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• Location: (name of site, street address):
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• Time of visitation:
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• Date of visitation:
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Interment
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• Location: (name of site, street address):
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• Time of interment:
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• Date of interment:
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Death
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• Date of death:
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• Place:
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• Cause:
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• Age:
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Birth
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• Date of birth:
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• Place:
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• Parents’ names:
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Military service
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Military service:
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Yes
No
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Branch of service:
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Date of enlistment:
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Date of discharge:
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Conficts:
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WWI
WW2
Korea
Viet Nam
Gulf
Other
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If other:
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Medals, honors:
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Personal information
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Occupation:
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Retired:
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Yes
No
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If retired, which year?:
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Name and city of high school attended:
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Degrees, certificates earned, names of institutions and years received:
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Name of city or state where raised:
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Churches or club memberships, awards, honors, offices held, miscellaneous information:
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Volunteer work and hobbies:
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Other information you’d like to include:
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Dates and locations lived in local area:
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Spousal information
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• Name:
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• Maiden name if female:
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• Deceased?:
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Yes
No
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If deceased, date of death?:
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• Wedding date:
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Wedding location:
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Children, siblings, parents & companions
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Enter name, relationship and city & state of residence for each person
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Name, relat., city & state:
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Grandchildren, great-grandchildren & great-great-grandchildren
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No. of grandchildren:
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Great-grandchildren:
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Great-great-grandchildren:
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Relatives that preceded the deceased in death
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Enter name and relationship of each person
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Name & relationship:
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Name & relationship:
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Name & relationship:
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Name & relationship:
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Name & relationship:
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Name & relationship:
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Name & relationship:
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Name & relationship:
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Name & relationship:
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Name & relationship:
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Memorial contributions (include address):
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For us to contact you if necessary
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• Contact name:
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• Contact phone:
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• Contact email:
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Click here to send photos for announcments via email. Be sure to include your name and contact information in the email so that we may get in touch with you if we have any questions.
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