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The Advocate
Death Notice for Print
Print this form and return to The Advocate
PLEASE TYPE OR PRINT CLEARLY
DEATH NOTICE
THE ADVOCATE
Phone: (225) 383-1111 Ex. 0289 or 388-0289
FAX (225) 388-0175
Lafayette Exchange - 233-8920
La. Toll Free WATS Line 1-800-960-6397
DEADLINE IS 3 p.m. DAILY
RATES - $2.15 per line/per day
GENERAL INFORMATION
Name of Deceased (Last, First Middle, Nickname):
__________________________________________________________
Check: Male___ Female___
Check: Retired Yes___ No____ Occupation:________________________
Resident (City):______________________________________________
Native (City & State):___________________________________________
Time/Day of Week/Date/Place of Death:
__________________________________________________________
Age:_____ If veteran branch/honors:______________________________
Visiting at__________________________________________
Hours/Day/Date_______________________________________
Religious service at_______________________________
Time_________________ Day/Date___________________
Conducted by________________________________________________
Dismissal__________________________ Entombment_________________
Interment__________________________ Other_______________________
Survivors: Wife-Husband___________________________________________
Father-Mother____________________________________________________
No._______ Daughters____________________________________________
______________________________________________________________
______________________________________________________________
No._______ Sons________________________________________________
_______________________________________________________________
_______________________________________________________________
No._______ Sisters_______________________________________________
_______________________________________________________________
_______________________________________________________________
No._______ Brothers______________________________________________
_______________________________________________________________
_______________________________________________________________
No. of Grandchildren_____ Great-Grandchildren_____ Great-Great-Grandchildren____
Preceded in death by________________________________________________
_________________________________________________________________
Pallbearers________________________________________________________
_________________________________________________________________
Honorary Pallbearers________________________________________________
________________________________________________________________
Educational background, Organizations, Honors, Special Interests or Hobbies:
________________________________________________________________
________________________________________________________________
Funeral Home in charge of arrangements and telephone numbers:
(Name of funeral home is required. We cannot print an obituary if the death is not verified.)
________________________________________________________________
| FOR CLASSIFIED USE ONLY Acct.:____________________________________________________________ Times Ran:_______________________________________________________ Total Lines:_______________________________________________________ Total Amount:______________________________________________________ Date to Acctg.:_____________________________________________________
|
BILLING INFORMATION
Date To Start:______________________________________________________
Run Dates:________________________________________________________
How Many Times:___________________________________________________
Advance Obit In Area:________________________________________________
Obit Clerk:________________________________________________________
Estimated Cost:___________________________________________________
Bill to:___________________________________________________________
Address:_________________________________________________________
City:_____________________________________________________________
State:____________________________________________________________
Zip:_____________________________________________________________
Phone No.:_______________________________________________________
Ordered By: Name and Phone Number:_________________________________
Read Back To:____________________________________________________
Proofed By:_______________________________________________________
If we have a question who is a family member with telephone number we can contact?:
______________________________________________________________
