Grand Chapter of Idaho
Order of Eastern Star
Deceased Member Form
2015-2016
Please provide as much information as possible to allow us an opportunity to create a complete
and compassionate memorial for every beloved member in their passing.
1. Attach the newspaper Obituary clipping and any additional information to this form.
Name:_________________________________ Date/Place of Birth: __________________________
Date/Place of Death: ______________________Cause of Death: ______________________________
Date/Place of Service (if applicable): _____________________________________________________
Place of Burial: _____________________________________________________________________
OES Initiation Date: ______________________Chapter/Location: ____________________________
VPLM (circle one) Y N
Honorary Life Member:
Y N
Golden Star: Y N
Dual/Plural Member: Y N
List Chapters/Location: ____________________________________
Chapter Offices/ Year Held: __________________________________________________________
Grand Chapter Offices/Appointments/Year Held: _________________________________________
Military Service (Branch/Dates of Service): _______________________________________________
Civic Awards/Charitable work involved in: _______________________________________________
Occupation: ____________________________
Church membership: _____________________
What was the Members passion in life (people/activities/interests, etc.): Attach additional sheet if needed.
_____________________________________________________________________________________
Deceased Member Form (cont). – Pg 2 of 2
2. Surviving Spouse Name/Address (if applicable): _______________________________________
____________________________________________________________________________________
OES Member: Y N
If so, list Chapter: ___________________________________
3. Other Surviving relations (Children/Grandchildren, etc. )_________________________________
__________________________________________________________________________________
4. Describe your fondest memories about this member: Attach additional sheet if needed
____________________________________________________________________________________
Chapter Secretary: _____________________________ Address: ________________________________
Email: _______________________________________ Phone: _________________________________
Please send all information to:
Mary McKinney, Grand Chaplain
PO Box 1053
Spirit Lake, ID 83869
(208) 301-3236
idvinemagicoes@yahoo.com