Obituary Form

* Indicates required field.

Last Name of Deceased. Do not include titles (such as Pastor, Mrs. or Dr.) or degrees (such as M.D. or Ph.D.)*

First Name of Deceased*

Middle Name or Initial (optional)

Maiden Name (if applicable)

Date of Birth. Use this format: July 26, 1923.*

City where member was born*

State where member was born*

Country where member was born, if other than U.S.

Date of Death. Must be in the last 12 months. Use this format: Sept. 7, 2009.*

City where member died*

State where member died*

SurvivorsSurvivors may include parents, siblings (not in-laws), spouse, children and step-children by name; grandchildren and great-grandchildren by number. Format survivor list exactly like this: "wife, Christine; sons, John, Karl; stepson, Robert; daughters, Michele Griner, Karyn White; five grandchildren; two great-grandchildren."

Optional Identification StatementYou may include up to 25 words describing the deceased person's church employment or lay ministry that made him/her well-known to the Adventist community (to more than one church). Examples include academy teacher, evangelist, conference president, Pathfinder area coordinator, pastor, ASI officer, or business person who served Adventists long-term (such as someone who catered Adventist events for 25 years). If in doubt, submit it. Such information will be included as space permits.

Name of Person Submitting Obit*

First

Last

Phone Number of Person Submitting Obit

Email of Person Submitting Obit

Recorder subscription*What shall we do with the deceased's Recorder subscription?

Stop the subscription

Keep the subscription as-is

Keep the subscription, but change the name/address (for this one, fill out the next field)

Optional: Recorder subscription change infoIf you selected option 3 above, note the new name/address for the subscription.

Seventh-Day Adventist Church

Obituary Form

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