We provide our On-line Obituary Information Form for the purpose of allowing you and your family to submit to us, the information about your loved one that you would like to appear in their obituary listing on our website, as well as, to be reported to local newspapers and/or periodicals for publication in their obituaries pages.

If you have any questions whatsoever, please contact Routsong Funeral Home & Cremation Services at 937-293-4137.
NOTE: Fields marked with an asterisk ( * ) are required. Any information you submit will be held in the strictest confidence - we do not release any information to outside parties under any circumstances.

Deceased Information
* First Name:
* Last Name:
Middle Name:
Sex:
Age:
Date of Death: (e.g. MM/DD/YYYY)
Name of the Place of Death
(home / hospital name / other)
Long / short Term Illness(es):
Residence Area
(specific community / town / city):
Date of Birth: (e.g. MM/DD/YYYY)
Place of Birth: City:

State:

Country:
Marital Status:
Full Name of Surviving Spouse
(if applicable)
If Wife, Provide Maiden Name:
Date of Death of Spouse
(if applicable):		 (e.g. MM/DD/YYYY)
Usual Occupation (most of life):
Employer:
Job Title:
Dates of Employment:
Dates of Retirement:
Education
Religious Affiliations:
Clubs / Organizations / Memberships / Hobbies:
Honors/Awards:

Veteran Information
Was Decendent Ever In the US Armed Forces?: Yes No (if no, continue to next section)
Branch of Service:
Date Enlisted: (e.g. MM/DD/YYYY)
Date Discharged: (e.g. MM/DD/YYYY)
Honorable Discharge: Yes No
Rank at Discharge:
Military Serial Number:
Is A Copy of Discharge Papers Available? Yes No (if no, please bring for us to copy):
Location where Discharge Papers are On File:

Survivors

Newspapers will only use names of the immediate family as listed below. The city or town and state of the survivors must be included - separate each piece of the individual's information with a comma and a space. If there is more than one person per each text area, then separate multiple individuals by hitting the 'enter' key so that they each appear on a new line in the text area.
Daughters:
Sons:
Parents:
Sisters:
Brothers:
Grandparents:
Number of Grandchildren:
Number of Great Grandchildren:

Funeral Service Information
Time of Service:
Street Address:
City:
Time of Service:

Church Information
Street Address:
City:
State:

Cemetery Information
Street Address:
City:
State:

Information about Informant / Person In Charge Regarding this Obituary
* First Name:
* Last Name:
Relationship To Deceased:
* Email Address:
Telephone Number:

Other Information & Instructions

Please list any other instruction or information you would like us to have. You may also use this free-form text area to write exactly how you would like the obituary worded, and we will include it as you have entered:


 

 
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Kettering Chapel
2100 E Stroop Rd
Kettering, OH 45429		 Centerville Chapel
81 North Main St
Centerville, OH 45459
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