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1005 South 8th East    Preston, Idaho 83263     Phone:(208) 852-0533     Fax:(208) 852-1073    
email: webbmortuary@gmail.com

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- Funeral Record -

(Information necessary for death certificate & obituary)

Deceased's Full Name Age
Address
Birth Date Birthplace
Doctor Time Of Death
Place Of Death
Father's Full Name
Birthplace
Mother's Full Name
Birthplace
Husband/Wife Of Died
Date Of Marriage Place
Husband/Wife Of Died
Date Of Marriage Place
Social Security # Years of Education
Occupation
Informant (Name & Relationship)
Address Phone#
Place of Funeral
Date of Funeral Time

Viewing

Officiant Cemetery
Dates & Times

Survivors

(Spouse, Children, Brothers, Sisters)

Name Spouse
Relationship Address (City & State)
Name Spouse
Relationship Address (City & State)
Name Spouse
Relationship Address (City & State)
Name Spouse
Relationship Address (City & State)
Name Spouse
Relationship Address (City & State)
Name Spouse
Relationship Address (City & State)
Name Spouse
Relationship Address (City & State)
Name Spouse
Relationship Address (City & State)
Name Spouse
Relationship Address (City & State)
Name Spouse
Relationship Address (City & State)
# Grandchildren # Great Grandchildren
#Great-Great Grand Children

Preceded In Death By:

Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship
Name
Relationship

Items for Obituary

(Activities, Interests, Hobbies, Church Involvement, etc.)


Veteran: Branch of Service Service#
VA File#
Date of Enlistment Place
Date of Discharge Place
Your Email (required)

Additional Information:



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