Memorial/Funeral Information Form

Memorial/Funeral Information Form
Thank you for completing this form. Please know that you and your family are in our prayers.
About the Deceased
Name

PrefixFirst NameMiddle NameLast NameSuffix
Preferred/Nickname
if different from first name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age
Date of Birth

MonthDayYear
Date
Date of Death

MonthDayYear
Date
Religion
Will there be a body presented at mass?
Date Requested

Monday - Friday
* Please don't list the same date multiple times.
1st choice

MonthDayYear
2nd choice

MonthDayYear
3rd choice

MonthDayYear

About the Deceased