Obituary/Death Notice Order Form
(Please Print)
The
Adams County Historical Society holds the respective obituary and death notices
noted in this listing. The fee for each obituary or death notice “look up” is
$10.00. All completed orders are mailed
first class and the photocopy and postage is included in the total. Orders may
take up to two weeks to complete. Payment may be made by Check or Money Order
(Made Payable to ACHS) or Master Card or Visa. Orders by credit card may be
faxed to 717-334-0722. Orders by Check and Money Order should be mailed to the
following:
The
ATT: Obituary/Death Notice Request
Name_____________________________________
Address___________________________________[1]
Telephone_________________________________
Email_____________________________________
Name of
Decedent___________________________
Newspaper__________________________________
Date Of Notice or Obituary_______________________
PAYMENT INFORMATION
Check___________ (Enclosed)
Money Order______ (Enclosed)
Credit Card________________ (Master Card
or Visa)
Credit Card
Number__________________________
Name on
Card________________________________
Expiration
Date________________________________
[1] When ordering by credit card the address given must match the credit card billing address on the monthly statement.