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Memorial / Funeral Online Form
DECEASED:
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DECEASED ADDRESS:
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Street Address
City
Alabama
Alaska
American Samoa
Arizona
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Northern Mariana Islands
Ohio
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Pennsylvania
Puerto Rico
Rhode Island
South Carolina
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Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
BAPTIZED:
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Yes
No
CONFIRMED:
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Yes
No
COMMUNICANT:
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Yes
No
CHURCH MEMBER:
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No
AGE AT DEATH
*
DATE OF DEATH:
*
MM slash DD slash YYYY
DATE OF BIRTH:
*
MM slash DD slash YYYY
PLACE OF BIRTH:
CAUSE OF DEATH:
OCCUPATION OR SIGNIFICANT ACTIVITIES:
FAMILY CONTACT PERSON:
*
First
Last
PHONE:
*
E-MAIL:
*
SURVIVING NEXT OF KIN AND RELATIONSHIP:
BURIAL:
MEMORIAL SERVICE:
RITE I
RITE II
PLACE OF SERVICE:
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Capacity for the Church is 250, Chapel is 100.
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CHAPEL
CHURCH
EUCHARIST:
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No
DATE OF SERVICE:
MM slash DD slash YYYY
TIME:
:
Hours
Minutes
AM
PM
AM/PM
DAY:
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
EXPECTED NUMBER OF ATTENDEES:
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PLACE OF INTERMENT:
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DATE OF INTERMENT:
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MM slash DD slash YYYY
MORTUARY:
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PHONE:
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ORGANIST:
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Yes
No
HYMNS:
FLOWERS:
OTHER FLORIST:
READINGS:
OLD TESTAMENT LESSON:
NAME OF READER:
PSALM:
EPISTLE LESSON:
NAME OF READER:
GOSPEL:
EULOGY:
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No
NAMES:
USHERS:
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No
NAMES:
CHARITABLE GIFTS:
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No
CHURCH:
OTHER:
ADDITIONAL COMMENTS:
Completed by:
Name:
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Last
Phone:
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Email:
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