The Criterion

City, ST

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- Obituaries
  - Obituary Form

Please submit this form to our office by 10 a.m. Thursday before the week of publication to be considered for that issue. Please use first and last names for all name fields. (If the form does not work for you, please send obituary notices directly to [email protected])

Note: Use the "Tab" key to move between fields; print this page for your own records (if you wish) BEFORE submitting the form.
This form is not accepting responses at this time.
- Deceased
  
  Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Male Female Please fill out this field.
  
  Age REQUIRED Please fill out this field. Please enter valid data.
  
  Parish REQUIRED Please fill out this field. Please enter valid data.
  
  Town REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Death REQUIRED Please fill out this field. Please enter valid data.
- Survivors: Please be sure to include the FIRST and LAST name of any survivors.
  
  Spouse: Please enter valid data.
  
  Children:
  
  Parents:
  
  Sisters:
  
  Brothers:
  
  Grandparents:
  
  Grandchildren (number): Please enter valid data.
  
  Great-Grandchildren (number): Please enter valid data.
  
  Great-great-Grandchildren (number): Please enter valid data.
  
  Additional comments:
- Criterion subscription: Check this box if the deceased was the last in his or her household and should have their subscription to The Criterion cancelled.
- Your information:
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
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