OBITUARY ORDER FORM

BLAIR COUNTY GENEALOGICAL SOCIETY

ROLLER-HOJETH MEMORIAL LIBRARY

431 SCOTCH VALLEY ROAD

HOLLIDAYSBURG, PA 16648

Please type or print legibly.

NAME: __________________________________________________________

ADDRESS: ______________________________________________________

CITY/STATE/ZIP: __________________________________________________

DATE: ___________________________________________________________

EMAIL ADDRESS: _________________________________________________

Please send me photocopies of obituaries for the following persons:

1. NAME AT TIME OF DEATH:

_________________________________________________________________

DATE OF DEATH: _________________________________________________

2. NAME AT TIME OF DEATH:

_________________________________________________________________

DATE OF DEATH: _________________________________________________

3. NAME AT TIME OF DEATH:

_________________________________________________________________

DATE OF DEATH: __________________________________________________

I enclose a $2 donation for each obituary plus a stamped, self-addressed envelope.