Death Notice Form

We provide our on-line Death Notice Form for the purpose of allowing you and your family to submit to us, the information about your loved one that you would like to appear in their death notice listing on our website, as well as, to be reported to local newspapers and/or periodicals for publication in their death notice pages, if you so choose.

If you'd prefer, a printer-friendly version of this form is also available for you to download and fill out manually. CLICK HERE for further instructions and the download link.

If you have any questions, please contact Howe-Peterson Funeral Home at 313-561-1500.

NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

Deceased Information
* First Name:
* Last Name:
Middle Name:
Sex:
Age:
Date of Death:	(e.g. MM/DD/YYYY)
Residence Area (specific community / town / city):
Date of Birth:	(e.g. MM/DD/YYYY)
Place of Birth:	City: State: Country:
Marital Status:
Full Name of Surviving Spouse (if applicable)
If Wife, Provide Maiden Name:
Date of Death of Spouse (if applicable):	(e.g. MM/DD/YYYY)
Usual Occupation (most of life):
Employer:
Job Title:
Years of Employment:
Religious Affiliations:
Clubs / Organizations / Memberships / Hobbies:
Honors/Awards:

Veteran Information
Was Decendent Ever In the US Armed Forces?:	Yes No (if no, continue to next section)
Branch of Service:
Honorable Discharge:	Yes No

Survivors
Newspapers will only use names of the immediate family as listed below. The city or town and state of the survivors must be included - separate each piece of the individual's information with a comma and a space. If there is more than one person per each text area, then separate multiple individuals by hitting the 'enter' key so that they each appear on a new line in the text area.
Daughters:
Sons:
Parents:
Sisters:
Brothers:
Grandparents:
Number of Grandchildren:
Number of Great Grandchildren:

Funeral Service Information
Time of Service:
Street Address:
City:
State:

Church Information
Name of the Church:
Church Telephone Number:
Name of Preferred Clergy:
Street Address:
City:
State:

Cemetery Information
Name of the Cemetery:
Cemetery Telephone Number:
Street Address:
City:
State:

Information About Informant / Person In Charge Regarding this Obituary
* First Name:
* Last Name:
Relationship To Deceased:
* Email Address:
Telephone Number:
Cell Phone Number:

Other Information & Instructions

Please list any other instruction or information you would like us to have. You may also use this free-form text area to write exactly how you would like the obituary worded, and we will include it as you have entered:

NOTE: Emails are not reviewed on weekends.

Death Notice Form - Printer-friendly Version

You can download the printer-friendly version of the Death Notice Form to your local computer from the link below. Once downloaded, open the PDF*, and enter your information on the form, then print it out on your printer. You may also print out the form and fax it, or bring it with you to the arrangement conference.

Dearborn Chapel fax:313-561-2363
Taylor Chapel fax:313-291-0919

» CLICK HERE to download the form - choose to, 'Save to Disk,' in the dialog box that appears (download times will vary depending upon connection.)

* NOTE: Adobe Acrobat Reader software is required to view this file - if you don't already have the Reader installed on your computer, it is available for free from Adobe's website - please click the icon at right to be taken to the download page.

22546 Michigan • Dearborn, MI 48124 • 313-561-1500 9800 S. Telegraph • Taylor, MI 48180 • 313-291-0900

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