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Obituaries

Submit Obituary Information

To submit your information online, complete the form below and click on "submit" button to send your information to us. Or you may print this page, and mail the completed form to us at Gay & Ciha Funeral and Cremation Services, 2720 Muscatine Ave., Iowa City, Iowa 52240

Please select one: Mr. Ms. Mrs. Miss
Name:
Date of Death:
City and state where deceased is from:
Age:
Birth Date:
Birth City & State:
Parents' Names:
Mother's Maiden Name:
Military Service: Yes No
   Branch:
    Years:
Occupation:
    Retired: Yes No
    Year:
Married: Yes No
Multiple Marriages: Yes No    
*Use commas to separate each marriage's info.
Spouse's Name:
Where Married:
When Married:
Maiden Name:
Current Spouse Deceased: Yes No
Affiliations: (Part-time or full-time resident, years of residency, church/clubs/job/affiliations, etc.)
Ties to area:
Survivors: (Spouse/Companion, Children, Grandchildren, Brothers, Sisters, Parents)
Please list Name, Relationship, & City, State of Residence:
Preceeded in Death By:
Services (Please indicate all that apply)
Service: Public Private
Funeral:
      Date:
      Time:
      Place:
Memorial:
      Date:
      Time:
      Place:
Graveside:
      Date:
      Time:
      Place:
Viewing:
      Date:
      Time:
      Place:
Other Service:
(Please specify)
      Date:
      Time:
      Place:
Disposition:
       Public Private
       Cremation Burial
      Date:
      Time:
      Place:
Contribution Information:
Funeral Home in Charge:
Phone Number of Funeral Home:
Family Contact (For publishing)
Name:
Phone Number:
Email Address:
Personal information, anecdotes, comments not included above: