Obituaries

Virgil Jansen
B: 1930-03-16
D: 2017-08-11
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Jansen, Virgil
Ava Powers
B: 1927-06-24
D: 2017-08-06
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Powers, Ava
Mary NeCollins
B: 1923-05-08
D: 2017-07-29
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NeCollins, Mary
Sr. Anne Mongoven OP
B: 1927-12-21
D: 2017-07-29
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Mongoven OP, Sr. Anne
Ruth Averkamp
B: 1930-08-19
D: 2017-07-20
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Averkamp, Ruth
Rita Helbing
B: 1957-06-27
D: 2017-07-14
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Helbing, Rita
Catherine Weber
B: 1920-09-09
D: 2017-07-05
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Weber, Catherine
Laura Dall
B: 1963-12-28
D: 2017-06-21
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Dall, Laura
Mary Richardson
B: 1924-03-18
D: 2017-06-19
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Richardson, Mary
Mary Salzmann
B: 1926-04-07
D: 2017-06-13
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Salzmann, Mary
LaVern Hill
B: 1921-07-13
D: 2017-06-05
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Hill, LaVern
Ervin Engelke
B: 1945-10-23
D: 2017-06-03
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Engelke, Ervin
Roselin Splinter
B: 1924-08-25
D: 2017-05-29
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Splinter, Roselin
Debra Kaiser
B: 1959-09-20
D: 2017-05-29
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Kaiser, Debra
Richard Schutjer
B: 1939-09-05
D: 2017-05-07
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Schutjer, Richard
Dorrance Dean
B: 1947-09-12
D: 2017-05-06
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Dean, Dorrance
Alice Kaiser
B: 1939-06-17
D: 2017-04-27
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Kaiser, Alice
Eugene Hasken
B: 1935-02-20
D: 2017-04-22
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Hasken, Eugene
Sr. Marie Cagnoni
D: 2017-04-22
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Cagnoni, Sr. Marie
Richard Weber
B: 1944-08-20
D: 2017-04-08
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Weber, Richard
Lois Alt Hendricks
B: 1929-07-10
D: 2017-04-07
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Alt Hendricks, Lois

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Cuba City, WI 53807
Phone: 608-744-2714
Fax: 608-744-3212

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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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