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In Memoriam Request
Please fill out as much information as possible. If any section does not apply, please leave that blank. If you have any questions at all, please contact the Council Staff office at (716) 851-5105 or email
councilstaff@buffalony.gov
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Requested date of completion
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MM
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DD
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YYYY
What Council Member(s) would you like to sign this memoriam?
Leah Halton-Pope - Ellicott District
David A. Rivera - Niagara District
Christopher P. Scanlon - South District
Bryan J. Bollman - Lovejoy District
Zeneta Everhart - Masten District
Joel P. Feroleto - Delaware District
Mitch Nowakowski - Fillmore District
Joseph Golombek, Jr. - North District
Rasheed N.C. Wyatt - University District
Requestor Information
Your name
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Your answer
Your email
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Your phone number
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In Memoriam Content
Please fill out the below information to the best of your abilities. If any section does not pertain, please leave that blank.
Name of person to be memorialized
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Your answer
Early Life
Tell us a little bit about where this person was born, their parents, and anything of note in their early life.
Birth date and location
Your answer
Names of Parents
Your answer
Education
Tell us about where they attended school, any degrees or special recognitions, and any accomplishments during their education.
Elementary, high school, and college information
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Degree
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Academic accomplishments
Your answer
Career
Tell us about any jobs they have had, as well as any awards or recognition they have recieved in their professional life.
Jobs and Titles
Your answer
Career accolades, award or recognition
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Family
Tell us about a significant other, family, and any other relevant family members that should be included.
If married, to whom and when did they get married?
Your answer
Any children, grandchildren, or other families to mention?
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Community
Tell us how this individual has made a positive impact on their community, volunteer service, or anything notable that they do in their free time.
Groups, community organizations, or houses of faith they have been involved with
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Accomplishments, or recognition given to help in their community
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Other
Did we miss anything that should be included? Please let us know here.
Anything else we should include?
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