Obituaries

Alice Lane
B: 1934-01-06
D: 2017-09-16
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Lane, Alice
Gladys Peavey
B: 1917-09-06
D: 2017-09-12
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Peavey, Gladys
Ethel Williams
B: 1933-04-30
D: 2017-09-11
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Williams, Ethel
Eugene Cook
B: 1920-02-23
D: 2017-09-05
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Cook, Eugene
Donna Green
B: 1919-09-11
D: 2017-09-04
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Green, Donna
Betty Fleer (Holman)
B: 1925-10-28
D: 2017-09-04
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Fleer (Holman), Betty
Johnnie Brown
B: 1930-06-16
D: 2017-09-02
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Brown, Johnnie
Addison Smith
B: 1942-08-19
D: 2017-08-31
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Smith, Addison
John Pardee
B: 1935-06-24
D: 2017-08-25
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Pardee, John
Alma Dailey
B: 1918-01-12
D: 2017-08-23
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Dailey, Alma
Harold Mezger
B: 1921-04-13
D: 2017-08-22
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Mezger, Harold
Robert Kuhn
B: 1947-09-12
D: 2017-08-21
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Kuhn, Robert
Pearl Haskins
B: 1944-05-20
D: 2017-08-19
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Haskins, Pearl
Shirley Holmes
B: 1947-12-27
D: 2017-08-16
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Holmes, Shirley
Betty Rea
B: 1923-05-28
D: 2017-08-15
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Rea, Betty
Jimmy Johnson
B: 1937-06-18
D: 2017-08-09
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Johnson, Jimmy
Joy-Lynn Reed
B: 1956-06-20
D: 2017-08-08
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Reed, Joy-Lynn
Charles Jamison
B: 1930-01-14
D: 2017-08-04
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Jamison, Charles
Peggy Kloxin
B: 1938-02-04
D: 2017-07-31
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Kloxin, Peggy
Betty Poling
B: 1923-03-24
D: 2017-07-24
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Poling, Betty
Shawn Richardson
B: 1970-09-13
D: 2017-07-18
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Richardson, Shawn

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3424 E 21st Street N
Wichita, KS 67208
Phone: (316) 686-7311
Fax: (316) 684-4265

Immediate Need

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

To report a death to Old Mission Mortuary, please notify us first by phone at (316) 686-7311.

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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