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Paid Obituary Submission Form - Survey
Please fill out the information below. Your obituary notice will be written by our staff based on the information you provide. You will also be contacted by a representative regarding payment, in addition to receiving a proof of your notice.
Contact information:
Please include your information so we may contact you regarding a final proof of your obituary notice, and to make payment arrangements.
Contact name:
Contact phone
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Contact e-mail
Papers Selection:
Please select from the list below what paper(s) you would like your announcement to be delivered to.
Newspaper
*
The Portland Tribune
The Beaverton Valley Times
The Clackamas Review
The Canby Herald
The Central Oregonian
The Estacada News
The Forest Grove News-Times
The Gresham Outlook
Hillsboro News-Times
The Lake Oswego Review
The Madras Pioneer
The Molalla Pioneer
The Newberg Graphic
The Oregon City News
The Regal Courier
The Sandy Post
The Sellwood Bee
Sherwood Gazette
Columbia County Spotlight
Southwest Community Connection
The Times
The West Linn Tidings
The Wilsonville Spokesman
The Woodburn Independent
General Information
Funeral home
*
Name of deceased
*
Maiden name - if female
City of residence
Service
Type of service
Funeral
Mass
Memorial
Graveside
Other
Access
Public
Private
Location of service
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Antigua and Barbuda
Aruba
Bahamas
Barbados
Belize
Canada
Cayman Islands
Cook Islands
Costa Rica
Cuba
Dominica
Dominican Republic
El Salvador
Grenada
Guatemala
Haiti
Honduras
Jamaica
Mexico
Netherlands Antilles
Nicaragua
Panama
Puerto Rico
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Trinidad and Tobago
United States
Argentina
Bolivia
Brazil
Chile
Colombia
Ecuador
Guyana
Paraguay
Peru
Suriname
Uruguay
Venezuela
Albania
Andorra
Armenia
Austria
Azerbaijan
Belarus
Belgium
Bosnia and Herzegovina
Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Estonia
Faroe Islands
Finland
France
Georgia
Germany
Greece
Hungary
Iceland
Ireland
Italy
Kosovo
Latvia
Liechtenstein
Lithuania
Luxembourg
Macedonia
Malta
Moldova
Monaco
Montenegro
Netherlands
Norway
Poland
Portugal
Romania
San Marino
Serbia
Slovakia
Slovenia
Spain
Sweden
Switzerland
Ukraine
United Kingdom
Vatican City
Afghanistan
Bahrain
Bangladesh
Bhutan
Brunei Darussalam
Myanmar
Cambodia
China
East Timor
Hong Kong
India
Indonesia
Iran
Iraq
Israel
Japan
Jordan
Kazakhstan
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Lebanon
Malaysia
Maldives
Mongolia
Nepal
Oman
Pakistan
Palestine
Philippines
Qatar
Russia
Saudi Arabia
Singapore
Sri Lanka
Syria
Taiwan
Tajikistan
Thailand
Turkey
Turkmenistan
United Arab Emirates
Uzbekistan
Vietnam
Yemen
Australia
Fiji
Kiribati
Marshall Islands
Micronesia
Nauru
New Zealand
Palau
Papua New Guinea
Samoa
Solomon Islands
Tonga
Tuvalu
Vanuatu
Algeria
Angola
Benin
Botswana
Burkina Faso
Burundi
Cameroon
Cape Verde
Central African Republic
Chad
Comoros
Democratic Republic of the Congo
Republic of the Congo
Djibouti
Egypt
Equatorial Guinea
Eritrea
Ethiopia
Gabon
Gambia
Ghana
Gibraltar
Guinea
Guinea-Bissau
Cote d'Ivoire
Kenya
Lesotho
Liberia
Libya
Madagascar
Malawi
Mali
Mauritania
Mauritius
Morocco
Mozambique
Namibia
Niger
Nigeria
Rwanda
Sao Tome and Principe
Senegal
Seychelles
Sierra Leone
Somalia
South Africa
Sudan
Swaziland
United Republic of Tanzania
Togo
Tunisia
Uganda
Zambia
Zimbabwe
Country / Region
* Please include the name of site in the first line.
Date and Time of service
MM
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DD
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YYYY
HH
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MM
AM
PM
AM/PM
Visitation
Location: (name of site, street address)
Date and Time of visitation
MM
/
DD
/
YYYY
HH
:
MM
AM
PM
AM/PM
Interment
Location: (name of site, street address)
Date and Time of interment
MM
/
DD
/
YYYY
HH
:
MM
AM
PM
AM/PM
Death
Date of death
MM
/
DD
/
YYYY
Place
Cause of death
Age
Birth
Date of birth
MM
/
DD
/
YYYY
Place
Parents' names
Military service
Military service
Yes
No
Branch of service
Date of enlistment
Date of discharge
Conflicts
WWI
WWII
Korea
Viet Nam
Gulf
Other
Medals & honors
Personal information
Occupation
Retired
Yes
No
If retired, which year?
Name and city of High School attended:
Degrees, certificates earned, names of institutions and years received:
Name of city or state where raised:
Churches or club memberships, awards, honors, offices held, miscellaneous information:
Volunteer work and hobbies:
Other information you’d like to include:
Dates and locations lived in local area:
Spousal information
Name:
Maiden name - if female:
Deceased?:
Yes
No
If deceased, Date of death:
Wedding date & location:
Children, siblings, parents & companions:
Enter name, relationship and city & state of residence for each person:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Name, relation, city & state:
Grandchildren, great-grandchildren & great-great-grandchildren:
No. of grandchildren:
Great-grandchildren:
Great-great-grandchildren:
Relatives that preceded the deceased in death:
Enter name and relationship of each person
Name & relationship:
Name & relationship:
Name & relationship:
Name & relationship:
Name & relationship:
Name & relationship:
Name & relationship:
Name & relationship:
Name & relationship:
Name & relationship:
Name & relationship:
Memorial contributions: (include address)
Photographs
Please use the are below to upload your photo(s) If you need to submit more than two photos, please let your representative know when you are contacted with your proof. We ask that you please limit the file size of your photo to 7 Megabytes or less.
Photo Upload
Please limit photo size to no more than 7 MB
Photo Upload
Please limit photo size to no more than 7 MB
Image Verification
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