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  • Given Name of Deceased REQUIRED Please fill out this field. Please enter valid data.
  • Name most commonly used Please enter valid data.
  • Address: REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY 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 valid data.
  • Date of Death REQUIRED Please fill out this field. Please enter valid data.
  • Gender REQUIRED (Select One) Male Female Please fill out this field.
  • Next of Kin/Family Contact REQUIRED Please fill out this field. Please enter valid data.
  • Next of Kin/Family Address REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • Relationship REQUIRED Please fill out this field. Please enter valid data.
  • Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  • Email REQUIRED Please fill out this field. Please enter an email address.
  • Date of Funeral Please enter valid data.
  • Funeral Home REQUIRED Please fill out this field. Please enter valid data.
  • Funeral Home Contact Please enter valid data.
  • Location of Funeral REQUIRED (Select One) Church Funeral Home Please fill out this field.
  • For the funeral, there will be: REQUIRED (Select One) Casket Urn None Please fill out this field.
  • Visitation Date and Time Please enter valid data.
  • Vigil Service REQUIRED (Select One) Rosary Prayer Service None Please fill out this field.
  • Vigil Service Presider Please enter valid data.
  • Priest will visit with family before visitation REQUIRED Yes No Not Applicable Please fill out this field.
  • Time of Visit Please enter valid data.
  • Eulogy at Vigil Only (Please note Eulogies are not allowed within the Mass) REQUIRED Yes No Not Applicable Please fill out this field.
  • Name of Person giving Eulogy Please enter valid data.
  • Special Requests for Vigil Please enter valid data.
  • Time of Funeral Mass Please enter valid data.
  • Celebrant, Concelebrants, Deacons Please enter valid data.
  • Family will meet at REQUIRED (Select One) Funeral Home Church Please fill out this field.
  • Family will be seated REQUIRED (Select One) before Mass during opening Hymn to be decided with priest or funeral home Please fill out this field.
  • Placing of the Pall by REQUIRED (Select One) Family Funeral Director to be decided with priest or funeral home Please fill out this field.
  • Placing of a Crucifix on the casket or urn REQUIRED Yes No Not Applicable Please fill out this field.
  • If cremains, family will carry in the urn Yes No
  • Opening Hymn Please enter valid data.
  • First Reading Please enter valid data.
  • Read by Family Member Sacristan or Lector
  • Responsorial Psalm Please enter valid data.
  • Second Reading Please enter valid data.
  • Read by Family Member Sacristan
  • Gospel Please enter valid data.
  • Chosen by Family Priest
  • Proclaimed by Priest Deacon
  • Homily delivered by Priest Deacon
  • Universal Prayer read by Family Member Deacon Sacristan or Lector Priest
  • Special Intercessions to include, if any
  • Presentation of Gifts by family (no more than 4 people) Yes No
  • Preparation Hymn Please enter valid data.
  • Communion Hymn Please enter valid data.
  • Ave Maria Yes No
  • Announce Luncheon Yes No Not Applicable
  • Closing Hymn Please enter valid data.
  • If cremains, family will carry out the urn Yes No
  • Internment/Inurnment Yes No
  • Internment/Inurnment held REQUIRED (Select One) Before the Meal No Meal No at this time Please fill out this field.
  • Location of Internment/Inurnment Please enter valid data.
  • Eulogy/Poem at Cemetery Only Yes No
  • Military Honors at Cemetery Yes No
  • If cremains, urn will be placed in the grave by Family Priest Funeral Director
  • Luncheon Yes No
  • Estimated number of luncheon guests Please enter valid data.
  • Video/Audio required at Luncheon Yes No
  • Special requests and homily notes

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