Campbell-Biddlecome Funeral Home
Vital information used to wright obituaries and forms that are required for a funeral service
Full Name First, Middle, Last (Maiden) if female *
Your answer
Date of Birth *
MM
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DD
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YYYY
Place of Birth City and State *
Your answer
Gender *
Age *
Your answer
Residence Address, City, State and Zip *
Your answer
Inside city limits *
Social Security Number
Your answer
Place of Death
Your answer
Address of the Place of Death City, State and Zip
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Date of Death
MM
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DD
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YYYY
Time of Death (am) (pm)
Time
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Race 2 *
Race / Indian Tribe Name / Other
Your answer
Name of Person in charge of Arrangements *
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Physical address of person in charge city, state and zip *
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Mailing Address of person in charge city, state and zip *
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Phone number of person in charge *
Your answer
Cell phone number of person in charge
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Name of Father of the deceased (first, middle and last) *
Your answer
Father deceased
Date of death (father)
MM
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DD
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YYYY
Name of mother of the decease (first, middle and maiden) *
Your answer
Mother deceased
Date of death Mother
MM
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DD
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YYYY
Occupation (the physical job, i.e. carpenter, banker etc.) *
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Type of Industry *
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Name of business *
Your answer
Date of retirement
Your answer
List other business names and location city and state
Your answer
Marial Status *
Name of spouse - first, middle, last (maiden name) *
Your answer
If spouse is deceased date of death
Your answer
Place of marriage city and state
Your answer
Education *
Military Service
War Time Service
Education *
Name of College
Your answer
Date of Graduation college
Your answer
Name of High School
Your answer
Date of Graduation High School
Your answer
Date of Enlistment
Your answer
Place of enlistment city and state
Your answer
Date of discharge
Your answer
Place of discharge city and state
Your answer
Memberships / Organizations / Church Memberships
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Surviving Children (Spouse Optional) city and state where they live
Your answer
Surviving Brothers and Sisters (Spouse Optional) city and state where they live
Your answer
Number of Grandchildren
Your answer
Number of Great-Grandchildren
Your answer
Number of Great-Great-Grandchildren
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Name and Relationship of Family members who have preceded in death
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Type of service requested
Name of Cemetery
Your answer
Name of Person in Charge of Cemetery
Your answer
Phone Number of Person in Charge of Cemetery
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Cemetery Location, county, city & state
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Headstone
Would like to purchase headstone
In lieu of Flowers Memorial Contributions can be made to: (Name and mailing address)
Your answer
Name of Minister - 1
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Phone number of minister -1
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Name of Minister - 2
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Phone number of minister -2
Your answer
Name of Soloist / Singers
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Songs for service
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Music Type
Name of Pianist and or Organist
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Name of Pallbearers (6)
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Name of Honorary Pallbearers
Your answer
Paid Obituaries to be placed in
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