Submission Form
for Polk County Obituaries

Your Name:
  
E-Mail Address: 
   
SURNAME for Obituary
(Please use ALL CAPS for SURNAME):
  
First Name followed by middle name or middle initial:
  
Date of Death:
  
Source of this Obituary:
  

Obituary Instructions:

  1. Only Obituaries of current or former residents of Polk County should be entered here.
  2. Type obituary in the space below.
  3. Please CAPITALIZE all SURNAMES.
  4. Click SUBMIT when complete.

     

Your submission should immediately appear on the page of new submissions.

 

     

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