Funeral Intake Form

Deceased Person's Information

Name of the Deceased*

First Middle Last

Age

Please enter a number from 0 to 120.

Date of Death

Address

Street Address Address Line 2 City State ZIP Code

Phone

Parish*

COTLF

Envelope Number

Family Information

Person Making Arrangements*

First Last

Relationship*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email

Funeral Home

Funeral Home*

Funeral Director

Wake Service

Wake Service*

Wake Service
No Wake Service

Date*

Start Time*

:

End Time*

:

Clergy*

Wake Other

Mass Information

Mass*

Mass
No Mass

Date*

Time*

:

Language*

Remains*

Casket
Ashes

Priest*

Mass Other

Graveside

Burial Information*

Following Mass
Interment at a Later Date
Cremation to Follow

Cemetary*

Date*

Time*

:

Clergy*

Burial Other*

NOTES

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Update

UPDATE

Submitted By:*

Other

Additional Notes

Phone

This field is for validation purposes and should be left unchanged.

Funeral Information Sheet

Deceased Person's Information

Family Information

Funeral Home

Wake Service

Mass Information

Graveside

NOTES