Name of Deceased *

First Name

Last Name

Date of Birth

MM

DD

YYYY

Date of Death *

MM

DD

YYYY

Vigil

Yes

No

Vigil Service

Yes

No

Next of Kin

First Name

Last Name

Cell Phone

(###)

###

####

Alternative Contact Person

First Name

Last Name

Read by

First Name

Last Name

Read by

First Name

Last Name

Read by

First Name

Last Name

Reception

(no funerals on Mondays if there is a reception)

Yes

No

Military honors

(arranged by funeral home)

Yes

No

Put programs & tissues in pews for family & pallbearers

Yes

No

I understand the following fees, where applicable

priest $250 (not required), organist $125, cantor $125

Yes

No