Obituaries

Phyllis Kuegeman
B: 1916-11-20
D: 2017-11-14
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Kuegeman, Phyllis
Ardis Critser
B: 1924-09-24
D: 2017-11-06
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Critser, Ardis
Terry Florence
B: 1945-09-25
D: 2017-11-06
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Florence, Terry
Mary Severson
B: 1927-06-21
D: 2017-11-02
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Severson, Mary
Ma Chin
B: 1928-04-04
D: 2017-10-28
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Chin, Ma
Timothhy Aday
B: 1957-12-31
D: 2017-10-22
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Aday, Timothhy
Dorothy Quimby
B: 1921-07-19
D: 2017-10-19
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Quimby, Dorothy
Delton Walker
B: 1954-07-28
D: 2017-10-05
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Walker, Delton
Mary Anne Pauletto
B: 1927-05-12
D: 2017-10-01
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Pauletto, Mary Anne
Oliver Standley
B: 1926-09-25
D: 2017-10-01
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Standley, Oliver
Melvin Potterf
B: 1924-10-01
D: 2017-09-30
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Potterf, Melvin
Marilyn Lewis
B: 1930-09-18
D: 2017-09-27
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Lewis, Marilyn
Gloria Krohn
B: 1922-12-15
D: 2017-09-13
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Krohn, Gloria
Lloyd King
B: 1929-12-24
D: 2017-09-11
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King, Lloyd
Mary Perry
B: 1920-03-18
D: 2017-09-08
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Perry , Mary
Joseph Denney
B: 1928-09-06
D: 2017-09-08
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Denney, Joseph
Albert Peel
B: 1949-09-12
D: 2017-08-29
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Peel, Albert
Carolyn Bice
B: 1949-05-31
D: 2017-08-27
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Bice, Carolyn
Beverly Gingery
B: 1929-09-18
D: 2017-08-27
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Gingery, Beverly
Arlene Allgood
B: 1933-08-08
D: 2017-08-17
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Allgood, Arlene
Robert Semmel
B: 1936-05-31
D: 2017-08-07
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Semmel, Robert

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965 W. Harvard Blvd.
Roseburg, OR 97471
Phone: (541) 673-4455
Fax: (541) 673-1290

Immediate Need

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

To report a death to Wilson's Chapel of the Roses, please notify us first by phone at (541) 673-4455.

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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