Obituary Submission

Obituary Submission
- Only one obituary may be submitted and published for each deceased Shareholder.
- Type in upper and lower case. Do not include words or names in all CAPS.
- Be sure to double-check your spelling and dates.
- CIRI reserves the right to edit obituaries for clarity, available space and news style.
Section 1: Information About the Deceased Shareholder
Title
First Name*
Last Name*
Middle (initial or nickname)
Suffix
Gender*
Age at Time of Death*
Shareholder’s Date/City of Death
Date of Death*

MonthDayYear
Place of Death
List where the deceased Shareholder died. For example, "Alaska Native Medical Center" or "Nursing Home" or "at home"; if unknown, type "unknown" or leave blank.)
State Shareholder Died

Street Address

Street Address Line 2

City

Zip Code
Shareholder’s Date/City of Birth
Date of Birth

MonthDayYear
City of Birth
State of Birth

Street Address

Street Address Line 2

City

Zip Code
Section 2: Surviving Family Members of the Deceased Shareholder

List the name and relationship of surviving family members. Due to space constraints, do not include deceased family members.
Surviving Family Members of the Deceased Shareholder
Only insert the name(s) of surviving family members, including their relationship (for example, “Jane Abc, Mother; John Abc, Father; Jack Abc, Son; Jill Abc, Sister”)
Section 3: Upload a Photo

Space permitting, obituaries may include a photo. The photo should show the Shareholder up close and in good focus. It must be in JPEG or PNG format.
Upload Photo(s)

You may upload multiple photos if needed.
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Section 4: Information about the Funeral Home, Hospital or Coroner

This information is required for us to obtain routine verification of death. (Note, this section is not for publication and may be duplicative of some information you provided above.)
Facility Name
List name of hospital, care facility or funeral home handling the deceased Shareholder
City
List the city in which the identified hospital, care facility or funeral home is located
State

Street Address

Street Address Line 2

CityList the state in which the identified hospital, care facility or funeral home is located

Zip Code
Section 5: Additional Notes
Notes about this obituary for CIRI, if any. (Note, this section is not for publication.)
Section 6: Your Information

This section is information about YOU.
Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email*
Your Relationship to the Deceased Shareholder*
Husband/Wife; Significant Other; Brother/Sister; Father/Mother; Aunt/Uncle; Grandparent; Friend; etc.
Section 7: Estate Contact

Please provide the name and address for the individual handling the deceased Shareholder's final affairs or general estate.
Name*

First NameLast Name
Phone Number*
Format: (000) 000-0000.
Email*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relationship to the Deceased Shareholder*
Husband/Wife; Significant Other; Brother/Sister; Father/Mother; Aunt/Uncle; Grandparent; Friend; etc.
Please verify that you are human*
Should be Empty:

Obituary Submission

Section 1: Information About the Deceased Shareholder

Shareholder’s Date/City of Death

Shareholder’s Date/City of Birth

Section 2: Surviving Family Members of the Deceased Shareholder

Section 3: Upload a Photo

Section 4: Information about the Funeral Home, Hospital or Coroner

Section 5: Additional Notes

Section 6: Your Information

Section 7: Estate Contact