Bereavement Notification and Resolution Request Form
If you are a member of Wheeler (or desiring to make notification on behalf of a member) and have recently experienced the death of a loved one, your Church family is concerned. Please complete the form below to make notification:
Deceased’s name:
*
Deceased is WABC Member:
*
Please Select
Yes
No
Date of Death
*
-
Month
-
Day
Year
Date
Are you requesting a resolution?
*
Please Select
Yes
No
Requester's Name
*
Requester's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Requester's Email
*
example@example.com
Requester's relationship to the deceased:
*
Please Select
Spouse
Parent
Sibling
Child
Grandparent
Other
If “Other” selected, please share who:
*
Additional details:
Service Date:
Church holding service, if any:
Funeral home name:
Funeral home location (city AND state):
Funeral home website address, if available:
Please verify that you are human
*
Submit
Should be Empty: