Obituaries

Lucy Jurgensen
B: 1929-04-05
D: 2017-08-09
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Jurgensen, Lucy
Terry Glenn
B: 1949-06-21
D: 2017-08-09
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Glenn, Terry
Darlene Rowell
B: 1930-04-19
D: 2017-08-06
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Rowell, Darlene
James Bonge
B: 1943-01-30
D: 2017-08-05
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Bonge, James
William Buckley
B: 1927-06-30
D: 2017-08-04
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Buckley, William
Marie Dillon
B: 1933-06-11
D: 2017-07-23
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Dillon, Marie
Steven Failla
B: 1957-10-14
D: 2017-07-22
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Failla, Steven
John Housley
B: 1960-06-25
D: 2017-07-22
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Housley, John
James Prucha
B: 1947-05-26
D: 2017-07-22
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Prucha, James
Keith Bouchard
B: 1969-09-19
D: 2017-07-21
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Bouchard, Keith
Mary Winter
B: 1923-04-01
D: 2017-07-19
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Winter, Mary
Kenneth Kulhanek
B: 1946-12-13
D: 2017-07-15
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Kulhanek, Kenneth
Gary Klein
B: 1944-02-28
D: 2017-07-14
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Klein, Gary
Thelma Sheibal
B: 1941-09-17
D: 2017-07-11
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Sheibal, Thelma
Kenneth Storm
B: 1935-03-27
D: 2017-07-06
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Storm, Kenneth
Donald Bastemeyer
B: 1949-12-20
D: 2017-07-06
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Bastemeyer, Donald
Ronald Leach
B: 1944-07-11
D: 2017-07-05
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Leach, Ronald
Douglas Busskohl
B: 1942-01-12
D: 2017-07-05
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Busskohl, Douglas
Jerry Andreasen
B: 1938-02-19
D: 2017-07-03
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Andreasen, Jerry
Leroy Stamp
B: 1927-02-04
D: 2017-07-01
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Stamp, Leroy
William "Bill" Wassom
B: 1951-12-22
D: 2017-06-26
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Wassom, William "Bill"

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21901 W. Maple Rd
P.O. Box 67
Elkhorn, NE 68022
Phone: 402-289-2222
Fax: 402-289-2223

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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:

Miscellaneous Notes and Instructions:

Please select one of the options below:

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Please contact me to schedule an appointment

Please place my information on file


 

 

 

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