This information will be forward to the Pastor, First Lady and Asst. Pastor.

Name of Surviving Family Member

 

Relationship to the Deceased

 

Contact E-Mail Address

 

Address

 

Telephone

 

Name of Deceased

 

Date of Death

 

Place of Death

 

Funeral Directors Name

 

Funeral Director Address

 

Funeral Director Phone

 

Place of Service

 

Date of Service

 

Time of Service

 

Additional Information

 

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