IMPORTANT NOTICE: This form is not an email response form. It must be printed, filled out, and mailed, faxed or brought to The Chronicle.

___________ _{Name in bold and caps}_______________, ____ _age ____,

  of   _____________ _address ______________ died   ____   _{Day of the week}   _____

at ____________ _where ______________.

_______ _He/She __________ was the husband/wife/widower/widow/parent (circle one) of ____________ _{Name (excluding maiden)} _____________ and

employed by/owned/operated/retired (circle one)

from company as a _______________ _{Job description} ___________________.

________ He/She_______ was a member of

_______________ _Church __________________.

Arrangements by: _____________________________________________
(Please include the name of the funeral home and city and state if outside of Muskegon.)

Person Submitting Form: _____________________________________________

Phone Number: _____________________________________________

The Chronicle
981 Third St
PO Box 59
Muskegon, MI 49443

or

The Chronicle Tri-Cities BureauB
213 Washington
Grand Haven, MI 49417

Submissions may also be faxed to (231) 722-2552