Obit Request Form

9 LIBRARIES - ONE CARD

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Obituary Request

Requestor Information

KRL does not send your obituary requests via email, we mail them to the
mailing address provided.If we need to contact you for further information,
please select a contact preference and add contact information as appropriate.

* Requestor Name:

* Contact me by:

Email Address:

Phone:

Mailing Address (Your obituary request will be mailed to this address.)

* Street:

* City:

* State:

Zip:

Deceased Information

* Full Name of Deceased:
(include nicknames)

* Place of Death:
(city/town, state, etc)

Date of Death

* Month (mm):

Day (dd):

* Year (yyyy):

Notes or additional information you would like to add:

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