Obituaries

Thomas Rainey
B: 1951-02-06
D: 2016-07-14
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Rainey, Thomas
Jewell Cobb
B: 1927-01-03
D: 2016-07-13
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Cobb, Jewell
Sondra Marote
B: 1939-12-07
D: 2016-07-09
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Marote, Sondra
Judy Segars
B: 1970-03-30
D: 2016-07-08
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Segars, Judy
Mildred Speakman
B: 1924-08-29
D: 2016-06-27
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Speakman, Mildred
R. Rachel Willis
B: 1925-04-24
D: 2016-06-21
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Willis, R. Rachel
Jimmy Jackson
B: 1953-08-30
D: 2016-06-20
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Jackson, Jimmy
Barbara Stone
B: 1939-02-25
D: 2016-06-19
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Stone, Barbara
Winston Jennings
B: 1922-02-11
D: 2016-06-18
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Jennings, Winston
Billy Madison
B: 1956-08-27
D: 2016-06-03
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Madison, Billy
Thomas Cannon
B: 1932-05-01
D: 2016-06-01
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Cannon, Thomas
Maude Slayton
B: 1929-11-20
D: 2016-05-28
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Slayton, Maude
Kathy Flurry
B: 1959-02-15
D: 2016-05-21
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Flurry, Kathy
Jessie Hairston
B: 1924-07-10
D: 2016-05-21
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Hairston, Jessie
Ella Vaughn
B: 1935-01-25
D: 2016-05-17
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Vaughn, Ella
Stephen Teele
B: 1945-02-14
D: 2016-05-17
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Teele, Stephen
LaVerne Robertson
B: 1924-07-26
D: 2016-05-09
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Robertson, LaVerne
Betty Mallard
B: 1935-09-14
D: 2016-04-26
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Mallard, Betty
Anita McReath
B: 1949-06-06
D: 2016-04-26
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McReath, Anita
Portia Britton
B: 1946-03-14
D: 2016-04-14
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Britton, Portia
Robert Ray
B: 1940-05-26
D: 2016-04-13
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Ray, Robert

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5317 Bessemer Super Highway
Midfield, AL 35228
Phone: (205) 425-9898
Fax: (205) 425-9797

Immediate Need

First, let us say that we are so sorry for your loss. If at this time you would prefer to expedite your time with our staff in the funeral home you may submit the basic yet required information beforehand. Simply use the Immediate Need form to submit these details to our staff.


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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Please place my information on file


 

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