UCLA

Death Notice

UCLA Office of the Chancellor

Deceased Age

 

Department Title

 

Date of Death Time of Death (if known)

 

Cause of Death (if known)

 

Date of Employment Started at UC Date Retired

 

Name of Surviving Spouse, Next of Kin, or Close Personal Friend

 

Address of Surviving Spouse, Next of Kin, or Close Personal Friend

 

Dependent (if other than Surviving Spouse or Next of Kin)

 

Address (if other than above)

 

Informant - Department – Extension

 

The University Flag (located at Pauley Pavilion) will be at half-mast on

The following offices have been notified by Email:

• CCS
• Releases@stratcomm.ucla.edu
• Micah Jones, Facilities, Custodian of the Flag (micahjones@facnet.ucla.edu)
• UCLA Directory Services (ucladir@it.ucla.edu)

The following offices will receive copies of this notice:

• Chancellor’s Communications Service, 3148 Murphy Hall, 140501
• Media Relations, James West Center, 143107 (discontinue distributing hard copy, per department is notified by Email)
• Payroll, 10920 Wilshire Blvd., 6^th Floor, 141648
• Academic Senate (faculty), 3125 Murphy Hall, 140801
• Campus Benefits, Suite 200, 10920 Wilshire Blvd., 146548
• Emeriti Center, 1116 Rolfe Hall, 143702
• UCLA Healthcare Human Resources Office, UCLA Wilshire Center, Suite 400, 166446