Notification of Death in Family or EPUBC Church Member

NAME OF DECEASED


FULL NAME:



SUBMITTER INFORMATION


FULL NAME:


PHONE NUMBER: (Example 555-5555)


EMAIL ADDRESS:


RELATIONSHIP TO DECEASED:



FUNERAL ARRANGMENT DETAILS


FUNERAL ARRANGMENTS


CHURCH/FUNERAL HOME:


DATE OF FUNERAL SERVICE:


TIME OF FUNERAL SERVICE: (Example 2:00pm)


CHURCH/FUNERAL HOME FAX NUMBER:  (Example 555-5555)


CHURCH/FUNERAL HOME EMAIL ADDRESS:



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