The following personal information should be gathered as soon as possible and will be helpful for the church, the funeral home, and any others who will be assisting with the deceased funeral  
 
Deceased full legal name (include nick names in parenthesis): ______________________________________________________________________________ 
 
Birth date (include city and state in which the person was born):_____________________  
 
Death Date:____________________________________________________________________  
 
Home Address:_________________________________________________________________  
 
Family Names (always indicate if someone is deceased): ___________________________ 
 
______________________________________________________________________________ 
 
______________________________________________________________________________ 
 
 
The names of the parents of the deceased:____________________________________________  
 
_____________________________________________________________________________ 
 
 
If deceased was married, what was the date of the marriage and where was the marriage (city & state)  
 
Spouses name: _________________________________________________________________ 
 
Names of all children (include names of spouses):  
 
 
 
 
 
Names of Grandchildren (including great grandchildren etc., if any):  
 
 
 
 
Names of Siblings: 
 
 

 

Church Membership:  
 
Name of the congregation:  
 
Location:  
 
Is the family requesting a specific Memorial Fund? Yes____ No____  
 
If yes, indicate the name of the organization and its address information ____________________ 
 
______________________________________________________________________________ 
 
Funeral/Memorial Service: Will the body be cremated: Yes____ No____  
 
Name of Funeral Home: __________________________________________________________ 
 
Location of Funeral Home: ________________________________________________________ 
 
Contact information Name of Funeral Director: _______________________________________  
 
Phone Number: __________________________________________________________________ 
 
Email Address: __________________________________________________________________ 
 
Time of Visitation (if offered): ______________________________________________________  
 
Time of the funeral: ______________________________________________________________ 
 
Date of Funeral: _________________________________________________________________ 
 
Name of Pall Bearers (normally there should be six): _________________________________ 
 
________________________________________________________________________________ 
 
________________________________________________________________________________ 
 
 
Will there be a graveside service? Yes____ No___ 
 
Will there be a reception following the service? Yes____ No ____ Location _______________ 
 
_____________________________________________________________________________ 
 
If the reception is to be held at St. Stephen, we will need to know if a meal is desired or just cake and coffee.  If a meal is to be offered, then the family will need to determine how many people the Care Team can expect for the dinner.