Funeral Request – newlifeag

Funeral Request Form

Christian Funeral & Burial Services Application Form

Deceased Full Name

Pet Name

Wedding Date and Place

Lived Mostly At

Last Resided At

Date of Birth

Place of Birth

Age at Death

Cause of Death

Date/Time/Place of Death

Education

College Name

College Place

Rank or Profession

Hobbies / Special Interests

Place of Employment

Father's Full Name

Mother's Full Name

Accepted Christ as Saviour and Lord

Yes

Details (If accepted Christ)

Christian Rite of Water Baptism by Immersion and Date

Attending New Life A/G Church Since

Favorite Hymn/Scripture

Any Unusual Experience with the Lord

Last Words or Requests

Funeral Service (Date/Time/Place)

Graveside Service (Date/Time/Place)

Reverend/Pastor Name

Signatory 1 Name & Relationship to Deceased

Signatory 1 Signature

Signatory 1 Date

Signatory 2 Name & Relationship to Deceased

Signatory 2 Signature

Signatory 2 Date

Primary Contact Name

Primary Contact Phone

Primary Contact City/Town

Primary Contact State/Country

Parents' Names

Spouse's Name

Children (Oldest to Youngest)

Brothers (Oldest to Youngest)

Sisters (Oldest to Youngest)

Number of Grand Children

Number of Great Grand Children

Number of Nieces

Number of Nephews