FUNERAL INTAKE FORM Celebrant:

FUNERAL INTAKE FORM Celebrant:
Date of funeral

MonthDayYear
Date
Time of Funeral

Hour Minutes

AM/PM Option
Date of Wake

MonthDayYear
Date
Time of Wake
Cemetery
Which type of service has the family requested?

Funeral MassFuneral Service (outside of Mass)Graveside only
Please choose one:

CasketUrnNo Remains Present
Name of Deceased
Age of Deceased
Date of birth

MonthDayYear
Date
Address of Deceased
Place of Death
Date of Death

MonthDayYear
Date
Next of Kin/Contact
Relationship to Deceased
Next of Kin Mailing Address
Cell Phone
Please enter a valid phone number.
Was there a previous service?
Name of Funeral Home
Funeral Director's Name
Phone Number
Please enter a valid phone number.
Note
Should be Empty: