Please Check the Newspaper You Wish this Notice to Appear in:

Canby Herald Yes No             Molalla Pioneer Yes No         Wilsonville Spokesman Yes No

Name and age of the deceased:

            Name 
             Age 
             Sex Male Female

Enter the date of Death:

Place and cause of death: 

Enter the date of Birth:

Where was the deceased born?

Parent's names:

Please supply a brief summary of schooling, and early life of the deceased:

Please supply the date and place of the marriage and the spouse's name.

Brief summary of career, military service and other important events in the deceased person's life.

What organizations, churches, civic groups did the deceased belong to?

Survivors (immediate family only). List hometown of each please.
Please Note: List grandchildren, great-grandchildren, nieces, etc. by number only. i.e. "13 grandchildren."

Please supply the date, time, and place of services for the deceased.

Minister officiating:     Name

Place of burial.

Name and phone number of funeral home in charge.

Memorial contributions to?

Please provide the following contact information:

            Name 
      Home Phone 

Pictures are welcome and can be e-mailed to cherald@eaglenewspapers.comor they can be dropped off or mailed with a copy of this form and a self addressed return envelope to  the Canby Herald,  241 N. Grant Street, Canby, Oregon  97013.
If you have any questions please call the Canby Herald at 503-266-6831.