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  Deceased Information
Name of deceased:
Sex: Female    Male
Age:
Maiden name (if married):
Place of death
(home/name of hospital/other):
Date of death:
Long/short illness:
Place of residence
(specific community/town/city):
Dates of residence in the
Buffalo or surrounding area:
Date deceased left the area (if applicable):
Birthplace (city/state):
Spouse:
Date of spouses death
(if applicable):
Occupation:
Name of Firm:
Job Title:
Dates of employment:
Date of retirement (if applicable):
Education (0-12):
College 1-5+:
Branch of Service:
Serial Number:
Date Enlisted:
Rank At Discharge:
Date Discharged:
Discharge On File At:


Religious affiliations:


Clubs, organizations, memberships, hobbies:


Honors/awards:


  Survivors

(The newspaper will only use names of the immediate family as listed below. The city or town and state of the survivors must be included)

Daughters:


Sons:


Parents:


Sisters:


Brothers:


Grandparents:


Number of grandchildren:
Great-grandchildren:
  Funeral Service Information
Time of Service:
Street Address:
City
State
  Church Information
Street Address:
City
State
  Cemetery Information
Street Address:
City
State
  Contact Information
Who can we contact
regarding this obituary:
Phone Number: