Obituary Request Form

Your Name

First NameLast Name

Your Email Address

example@example.com

Please take a moment to double-check the email address you typed. If the email address is incorrect, you will NOT receive a confirmation of your request.

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Library Card Number

Name of Deceased Person

First NameLast Name

Please supply any information that you are able to below. If you do not know the date of death, give an approximate date and explain in the notes field. You may also call library staff at 419-259-5233.

Date of Obituary (Year, Month, Day)

Date

Date of Death (Year, Month, Day)

Date

Name of Newspaper

Page

Additional Information

The copyright law of the United States (title 17, United States Code) governs the making of photocopies or other reproductions of copyrighted material.

Under certain conditions specified in the law, libraries and archives are authorized to furnish a photocopy or other reproduction. One of these specific conditions is that the photocopy or reproduction is not to be “used for any purpose other than private study, scholarship, or research.” If a user makes a request for, or later uses, a photocopy or reproduction for purposes in excess of “fair use,” that user may be liable for copyright infringement.