Obituaries

Jane Bound
B: 1935-03-23
D: 2018-02-19
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Bound, Jane
Sharon Nigh
B: 1944-09-23
D: 2018-02-18
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Nigh, Sharon
Betty Eisele
B: 1922-03-26
D: 2018-02-18
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Eisele, Betty
James Kemmeter
B: 1942-09-28
D: 2018-02-07
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Kemmeter, James
Sally Gross
B: 1934-12-05
D: 2018-02-07
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Gross, Sally
Hans Wallace
B: 1960-09-15
D: 2018-02-05
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Wallace, Hans
Geneva Keller
B: 1921-08-12
D: 2018-02-04
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Keller, Geneva
Bette Rogneby
B: 1941-06-18
D: 2018-02-04
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Rogneby, Bette
Theresa Rueth
B: 1943-06-23
D: 2018-01-26
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Rueth, Theresa
Kathleen Braunschweig
B: 1942-08-25
D: 2018-01-23
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Braunschweig, Kathleen
LaVere Garity
B: 1933-11-13
D: 2018-01-22
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Garity, LaVere
Rita Doeberlein
B: 1941-10-01
D: 2018-01-22
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Doeberlein, Rita
Thomas Garity
B: 1955-10-31
D: 2018-01-16
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Garity, Thomas
Michael Gross
B: 1961-03-23
D: 2018-01-13
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Gross, Michael
Mary Ganser
B: 1926-08-02
D: 2018-01-10
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Ganser, Mary
Stanley Lukaszewski
B: 1925-01-22
D: 2018-01-08
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Lukaszewski, Stanley
Janet Palmer
B: 1946-10-20
D: 2018-01-03
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Palmer, Janet
Helen Stowe
B: 1927-08-01
D: 2018-01-02
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Stowe, Helen
Channing Michalski
B: 1971-04-09
D: 2018-01-02
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Michalski, Channing
Dale Russell
B: 1941-12-26
D: 2017-12-28
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Russell, Dale
Barbara Whiting
B: 1950-03-16
D: 2017-12-27
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Whiting, Barbara

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Jefferson, WI 53549
Phone: 920-674-3960
Fax: 920-674-6446

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I. Biographical Information
Full Name:
Date of Death:
Address1:
Address2:
City Name:
State:
Zip Code:
Telephone Number: (xxx-xxx-xxxx)
Email Address:
Date of Birth: (month/day/year)
City of Birth:
State of Birth:
Highest Education Level:
Please select Grade/Years of Education completed:
   
Social Security Number: For security reasons, we will contact you to complete the pre-arrangement.
Residence History:
Father's Name:
Father's City of Residence:
Mother's Name:
Mother's City of Residence:
Mother's Maiden Name:
Spouse's Name:
Spouse's Maiden Name:
Survivors' Names and Cities of Residence
Relatives Who Have Preceded In Death
Occupation:
Business Type:
Company Name:
Church Membership:
Lodge or Union Name:

II. Military Record
Veteran:
Branch of Service:
Serial Number:
Date Enlisted: (month/day/year)
Date of Discharge: (month/day/year)
Rank at Discharge:
Location of a Copy of Discharge (DD214):
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences
Type of Service:
Visitation Hours:
Casket:
Person in Charge of Arrangements:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Outer Container Preference: (for ground burial)
Cemetery Name:
Cemetery Location:
The cemetery property is in the name of:

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