Northwest Arkansas Genealogical Society
c/o Bentonville Public Library
405 S. Main St.
Bentonville, AR 72712
(479) 271-6820
E-mail:[email protected]

For obituaries by e-mail, send your request to: Wilma Fields [email protected]

OBITUARY REQUEST FORM
Fill in the following information from the Index to request a copy of an obituary from the NWAGS
Online Obituary Index. Please include $3.00 for each obituary requested and a Self Addressed Stamped
Envelope. You may request up to three (3) obituaries per SASE. A scanned version of the obituary can
be sent to your e-mail address instead of the mailed paper copy at your request. Please mark the
appropriate box below.

NAME_______________________NEWSPAPER__________________DATE____________AMOUNT_

1.________________________________________________________________________________________

2.________________________________________________________________________________________

3.________________________________________________________________________________________

4.________________________________________________________________________________________

5.________________________________________________________________________________________

6.________________________________________________________________________________________

TOTAL AMOUNT ENCLOSED:_________________

Please send to:
NAME: __________________________________________________________________________________
ADDRESS: _______________________________________________________________________________
CITY:_____________________________________ STATE: _____________ ZIP CODE: ______________
PHONE ___________________________________ E-MAIL: ______________________________________
HOW DO YOU WANT THESE SENT TO YOU?
Please mark only one box.
(  ) USPS - 1st Class Mail? - Include a Self Addressed Stamped Envelope for every three (3)
obituary requests.
(  )Digital Image(s) E-mailed To You? - Omit the SASE but you MUST include your E-mail
address above.
Obituaries will be sent when payment has been received.
Thank You!