St. Ann Funeral Form
Date & Time of Mass will be confirmed by our office once the form is submitted.
Full Name of Deceased:
First Name
Middle Name
Last Name
Address of Deceased:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Date of Death:
-
Month
-
Day
Year
Date
What Catholic Sacraments were received by the deceased? (Select all that apply)
Baptism
First Communion
Confirmation
Sacramental Marriage
Body or Cremation?
Body
Cremation
Please provide the names of surviving immediate family & relationship to deceased:
What date and time would you like for the Mass? (Mass usually begins at 10am)
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Any other specific date and time, if the above selection is not possible.
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Would you like our Bereavement Committee to pray a Rosary before Mass? (it would begin 30 minutes before the start of Mass)
Yes
No
Please list any hymn requests you may have for the Mass:
(Ave Maria, On Eagles Wings, Here I Am Lord, Amazing Grace, etc...)
Readings for the Funeral Mass:
I would like Father to select the readings.
I would like to select the readings (readings will be sent to you to choose from).
I have already selected readings (please provide them in the box below).
Readings:
These must be readings specific to the funeral liturgy.
Do you have family members (2) who would like to read the readings and prayers?
Yes
No
Date of Burial:
-
Month
-
Day
Year
Date
Place of Burial:
Name of Cemetery (even for cremation, the ashes MUST be buried or placed in a columbarium).
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like a meal, provided by our Bereavement Committee, in the Parish Hall? (this would follow the Graveside, if the Bereavement Committee is available)
Yes
No
How many people would be attending the meal?
Do you have a slide show that you would like projected on the screen during the meal (you are responsible for providing the slideshow via USB)?
Yes
No
Would you like a microphone available for people to share memories or a eulogy during the meal? (eulogies are not permitted during the Mass)
Yes
No
Relative's Contact Number
Please enter a valid phone number.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Funeral Home
Name of Funeral Home (Laurel Land, Lucas, Greenwood, etc.)
Funeral Home Contact Name
First Name
Last Name
Funeral Home Contact Phone
Please enter a valid phone number.
Do you have any questions? Please ask in the space below or feel free to call us:
If you chose to have a Rosary before Mass, please upload a picture you would like used on the Rosary pamphlet:
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