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THE GAZETTE'S DEATH NOTICE FORM

 

Basic Information

First name and middle name/intial:*
(middle name/intial is optional)
Last name:* Suffix:
Gender:* Male Female
Date of birth: (mm/dd/yyyy)
Date of death:* (mm/dd/yyyy)
Local city of residence:*
Zip code
Deceased must have been a Colorado Springs area resident within the last five years or the majority of his/her life or a former Colorado Springs resident with local services or burial.
Resident from:* Long time resident
Life long resident
Years: to (years only)
Occupation and/or Branch of military service:

Survivors

Is there a surviving spouse and/or children/stepchildren? Yes No

Visitation and services options

Service (indicate type):
If other please indicate:
Services Date: (mm/dd/yyyy)
Services Time (start):
Services End Time:
Location:
If Location is "Other..." then fill out below:
Location Name:
Location Address (street only):

Burial

Burial Type:
Location:
If Location is "Other..." then fill out below:
Location Name:
Location Address:
Location City:
Location State: (we only print burial information if in Colorado)

REQUIRED: Arranging funeral home

(include even if out of town or state; include full address and phone number):
Funeral Home Name:*
Address:*
City:*
State:*
Zip:*
Phone:* (719-555-1212)

Contacts

Information pertaining to Memorial Contributions is not published, due to space limitations.
Family/Main Contact:*
Family/Main Contact Phone:* (719-555-1212)
Alternate Contact:
Alternate Contact Phone: (719-555-1212)
Your E-mail address:*
Check for errors before you submit this form
  • Is the name spelled correctly?
  • Is the date of death correct?
  • Are the service times correct?

  • Please notify us of any errors or problems at the time of entry (not the following day).
    We will not re-run notice corrections.
    Email:deathnotices@gazette.com
    If faxing form please call (719)636-0183 to verify receipt.