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Funeral Planning

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  Please use this form to begin the process of planning the funeral.
  
  DECEDENT'S INFORMATION
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Parishioner Yes No
  
  Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Birthplace Please enter valid data.
  
  Marital Status Singled Married Widowed Divorced
  
  Date of Death REQUIRED Please fill out this field. Please enter a date.
  
  Biography
  Faith Formation, Community Involvement, Military Service, Professional Background, Organizations, Education, Etc.
  
  Family Members
  
  Member of Parish Organization / Ministry
  
  FUNERAL HOME
  
  Funeral Home's Name Please enter valid data.
  
  Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  FUNERAL MASS
  
  Please Select One Casket Urn
  
  Vigil (Wake Service)
  
  Burial
  
  CEMETERY
  
  Cemetery Name Please enter valid data.
  
  Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  FAMILY CONTACT
  
  Contact's Name
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Relantionship Please enter valid data.
  
  Address Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Submit
  
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