Obituaries

Norma Palmer
B: 1931-12-29
D: 2017-05-23
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Palmer, Norma
Beverly Jolley
B: 1925-10-22
D: 2017-05-20
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Jolley, Beverly
Calvin Louthan
B: 1926-09-09
D: 2017-05-17
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Louthan, Calvin
Jack Cutsforth
B: 1925-07-19
D: 2017-05-15
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Cutsforth, Jack
Margaret Smith
B: 1942-07-01
D: 2017-05-02
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Smith, Margaret
Jean White
B: 1925-12-08
D: 2017-05-01
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White, Jean
Clara Howe
B: 1927-02-15
D: 2017-04-30
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Howe, Clara
Jerry Smith
B: 1947-10-18
D: 2017-04-27
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Smith, Jerry
Robert Dains
B: 1972-11-04
D: 2017-04-27
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Dains, Robert
Donald Wolfe
B: 1931-06-20
D: 2017-04-25
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Wolfe, Donald
Barbara Tilton
B: 1951-01-15
D: 2017-04-20
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Tilton, Barbara
James Wiggins
B: 1939-02-21
D: 2017-04-19
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Wiggins, James
Douglas Rives
B: 1942-11-04
D: 2017-04-19
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Rives, Douglas
Rayna Daily-Moseley
B: 1964-02-01
D: 2017-04-18
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Daily-Moseley, Rayna
James Atkinson
B: 1980-08-23
D: 2017-04-15
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Atkinson, James
Mary Allen
B: 1931-06-05
D: 2017-04-10
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Allen, Mary
Robert Azevedo
B: 1923-05-23
D: 2017-04-07
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Azevedo, Robert
Duffy Reed
B: 1969-06-30
D: 2017-04-06
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Reed, Duffy
William Blake
B: 1946-09-15
D: 2017-04-06
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Blake, William
Mark Root
B: 1967-09-16
D: 2017-04-05
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Root, Mark
Mark Reed
B: 1952-04-22
D: 2017-04-01
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Reed, Mark

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4365 River Road North
Keizer, OR 97303
Phone: (503) 393-7037
Fax: (503) 393-6668

Immediate Need

First, let us say that we are so sorry for your loss.

To report a death to Keizer Funeral Chapel, please notify us first by phone at (503) 393-7037.

After that call, we will take your loved one into our care and will confirm a time/date for the arrangement conference. If you would prefer to expedite your time with our staff during that arrangement process, you may enter your loved one's basic information in this form below.


I. Informant Information

Full Name of Informant:
Relationship to Deceased:
Informant's Phone Number:
Informant's Email Address:

II. Decedent's Biographical Information

Full Name of Decedent:
Date of Death:
Decedent's Address:
City Name:
State:
Zip Code:
Telephone Number:
Date of Birth:
City of Birth:
State of Birth:
Highest Education Level:
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/Residence
Preceded Relatives
Occupation:
Industry:
Employer's Name:
Church Membership:
Club Affiliations:

III. Decedent's Military Record

Veteran:
Branch of Service:
Serial Number:
Date Enlisted:
Date of Discharge:
Rank at Discharge:
Time of Military Service:
Military Honors at Graveside:
Flag Preference for Service:

III. Service Preferences

Type of Service:
Visitation Hours:
Casket:
Officiating Clergy:
Pallbearers:
Flower Preference:
Music Selection:
Jewelry:
Glasses:
Casket Preference:
Disposition:
Cemetery Name:
Cemetery Location:

Miscellaneous Notes and Instructions:


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