Obituaries

John Ruma
B: 1940-12-03
D: 2017-06-18
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Ruma, John
Cody Warden
B: 1972-10-31
D: 2017-06-17
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Warden, Cody
William Welniak
B: 1933-07-26
D: 2017-06-15
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Welniak, William
Richard Curtis
B: 1937-06-28
D: 2017-06-08
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Curtis, Richard
Lorraine Quinn
B: 1947-09-28
D: 2017-06-06
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Quinn, Lorraine
Edna Concannon
B: 1918-02-10
D: 2017-06-03
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Concannon, Edna
Matthew Harvey
B: 1997-12-06
D: 2017-06-03
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Harvey, Matthew
Elizabeth McArdle
B: 1924-08-07
D: 2017-05-26
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McArdle, Elizabeth
Betty Fanckboner
B: 1924-08-14
D: 2017-05-23
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Fanckboner, Betty
Carolyn Rawlings
B: 1922-12-24
D: 2017-05-19
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Rawlings, Carolyn
Kristina Cole
B: 1962-05-27
D: 2017-05-15
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Cole, Kristina
Donna Speece
B: 1926-08-20
D: 2017-05-14
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Speece, Donna
Lorena Stauffacher
B: 1940-03-11
D: 2017-05-12
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Stauffacher, Lorena
Thomas Batten
B: 1942-04-03
D: 2017-05-11
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Batten, Thomas
Steven Kroymann
B: 1961-03-12
D: 2017-05-09
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Kroymann, Steven
Elton Weidner
B: 1932-01-02
D: 2017-05-08
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Weidner, Elton
Olivia Kopiasz
B: 2017-05-03
D: 2017-05-05
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Kopiasz, Olivia
Roger Olson
B: 1941-08-20
D: 2017-05-03
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Olson, Roger
Dr. Anil Agarwal
B: 1945-01-01
D: 2017-05-02
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Agarwal, Dr. Anil
Christina Neth
B: 1932-06-06
D: 2017-04-28
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Neth, Christina
Matthew Besse
B: 1980-05-27
D: 2017-04-27
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Besse, Matthew

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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:

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