1. GENERAL INFORMATION

Name of Deceased

Class

Cullum #

Date of Death

Place of Death (City & State)

Cause of Death

Place of Burial

Classmates or other graduates
attending wake or funeral

Address

Relationship
(room/teammate, etc.)

Which classmate(s) or other grad(s) (other than above) were close to the deceased as a cadet/in military service, etc.?

Did any classmate discuss/volunteer to write the memorial article?   Yes    No
If yes, please provide name and any other pertinent information.
 
 

If no, are you aware of any classmate or friend who might be able to write the memorial article?
 
 

Did any classmate give a eulogy?   Yes    No
If yes, please provide name and any other pertinent information. (Please try to obtain copy of eulogy.)
 
 

Eulogy attached?   Yes    No

Is a memorial fund being established?   Yes    No
If yes, please provide information.
 
 

2. NEXT OF KIN

Name

Relationship

Address

Phone #

City

State

Zip

E-mail address

Will this be the NOK residence for the near future?   Yes    No    Unknown
If no, please provide forwarding address:
 
 

Address

City

State

Zip

E-mail address

Is there someone who the NOK would prefer to write a memorial article?   Yes    No
If yes, please provide name and address:
 
 

Address

Phone #

City

State

Zip

E-mail address

Surviving Children

Name

Approx. Age

USMA Grad/Class

Other Info

3. OTHER INFORMATION

Please fax or mail to the address at the top of the page.

 A photo of deceased acceptable to next of kin

 Copies of any/all eulogies if available

 Copies of newspaper articles relating to the deceased

 Mass cards or other church/memorial service handouts on the deceased